Validity and reliability of the SPORTS score

Purpose  

Successful outcomes for an athlete usually consist of returning to their sport. The Subjective Patient Outcome for Return to Sports (SPORTS) score has been recently proposed as an easy to use score for evaluating an athlete’s ability to return to their sport. The aim of this study was to test the reliability and validity of the SPORTS score in athletes 5–10 years after anterior cruciate ligament reconstruction.     

Incidence and prevalence of diagnosed coeliac disease in Finland: Results of effective case finding in adults

Objective. The majority of patients with coeliac disease remain undetected world-wide. Finland has aimed at a high detection rate by training health personnel, and has advocated serologic screening for known coeliac disease risk groups. The purpose here was to assess whether this approach has been effective in clinical practice. Material and methods. The study was based on a prospective database of new coeliac patients aged 16 years or more, to whom the Social Insurance Institution had paid monthly compensation for the additional cost of maintaining a gluten-free diet since 2002. To obtain this compensation the diagnostic criteria for coeliac disease, including biopsy findings, had to be attested in a statement from a physician. The incidence and prevalence rates were calculated until the end of 2006. The total population aged 16 years or more was 4.31 million. Results. In 2004–06, a total of 5020 persons (64% female) receiving a new dietary grant were identified through the database. The mean annual incidence of proven coeliac disease was thus 39 per 100,000 individuals. Altogether, 23,553 persons received the dietary grant. This gives a nation-wide point prevalence of adult coeliac disease of 0.55% (0.70% F, 0.38% M). There was a regional variation from 33 to 49 per 100,000 in the annual incidence and from 0.41% to 0.72% in the prevalence of coeliac disease. Conclusions. To the best of our knowledge, these figures for proven coeliac disease are the highest reported. Increased alertness to the condition and active case finding has made this efficient diagnostics possible.     

Diagnosis of cervical and thoracic musculoskeletal spinal pain receptive to mechanical movement strategies: a multicenter observational study

Background: The McKenzie’s Mechanical Diagnosis and Therapy (MDT), which uses a combination of repeated movements and sustained positions to affect signs and symptoms, is commonly used for the conservative evaluation and management of cervical and thoracic spinal conditions.

Objective: Report a consecutive cohort of neck and thoracic pain patients managed using MDT and to record their classifications and physiotherapy management strategies.

Methods: Therapists provided demographic data on themselves and the patients, clinical data on the patients, and Neck Disability Index scores at baseline and final visit.

Results: Sixteen therapists collected data on 138 patients at baseline, of who 120 (87%) were followed up three to five visits later; these were patients with 131 cervical and seven thoracic problems. The therapists and patients are described. Regarding MDT classifications 83% were recorded as cervical and 100% as thoracic Derangement; there was a Directional Preference for extension in 80% of cervical spine patients, and 100% of thoracic spine patients. In addition, 13% of cervical spine patients were classified as OTHER, for which specific classifications were given. Classifications remained stable between initial and discharge sessions in 94% of patients. Neck Disability Index scores reduced from a mean of 24–12 at discharge (P < 0.001).

Conclusions: Routinely collected data can describe both therapists and patients involved, demonstrate the MDT classification clinical utility in terms of prevalence and stability between visits, provide information on the clinical course of this patients’ population, which could help establish treatment efficacy. Randomized controlled trials are needed to test for efficacy.     

Clinical review: Lung imaging in acute respiratory distress syndrome patients - an update

Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.     

Aberrant somatic hypermutation in multiple subtypes of AIDS-associated non-Hodgkin lymphoma

The pathogenesis of AIDS-related non-Hodgkin lymphomas (AIDS-NHLs) is associated with chromosomal translocations that deregulate the expression of various oncogenes. Recently, a novel mechanism of genetic lesion, termed aberrant hypermutation, has been identified in diffuse large B-cell lymphoma (DLBCL) of immunocompetent hosts. In these tumors, the somatic hypermutation (SHM) process that normally targets immunoglobulin V (IgV) genes in B cells appears to misfire and causes mutations in the 5' sequences of multiple proto-oncogenes, including PIM-1, PAX-5, RhoH/TTF, and c-MYC. To investigate whether aberrant hypermutation occurs also in AIDS-NHL, we studied the mutation profile of these 4 genes in various histologic subtypes. Mutations in 1 gene or more were detected in 19 of 39 (48.7%) AIDS-NHL cases (10 of 18 AIDS-diffuse large B-cell lymphoma; 4 of 11 AIDS-Burkitt lymphoma; 4 of 6 AIDS-primary effusion lymphoma; 1 of 4 AIDS-primary central nervous system lymphoma), with 9 of 39 (23.1%) cases carrying mutations in 2 or more genes. Overall, PIM-1 was mutated in 5 of 39 (12.8%), PAX-5 in 8 of 39 (20.5%), RhoH/TTF in 9 of 39 (23.1%), and c-MYC in 7 of 27 (25.9%) AIDS-NHL cases. Mutations were represented mainly by single base pair substitutions (n = 63) with rare deletions/insertions (n = 5) and displayed features typical of the IgV-associated SHM process. In addition, a number of mutations in PIM-1 and c-MYC were found to affect coding exons, leading to amino acid substitutions with likely functional consequences. Analysis of intraclonal heterogeneity documented that the aberrant hypermutation activity may be ongoing in at least some cases. These data indicate that aberrant hypermutation is associated with various subtypes of AIDS-NHL and may represent a major contributor to their pathogenesis.     

Validation of diffuse correlation spectroscopy against 15O-water PET for regional cerebral blood flow measurement in neonatal piglets

Diffuse correlation spectroscopy (DCS) can non-invasively and continuously asses regional cerebral blood flow (rCBF) at the cot-side by measuring a blood flow index (BFI) in non-traditional units of cm²/s. We have validated DCS against positron emission tomography using ¹⁵O-labeled water (¹⁵O-water PET) in a piglet model allowing us to derive a conversion formula for BFI to rCBF in conventional units (ml/100g/min). Neonatal piglets were continuously monitored by the BabyLux device integrating DCS and time resolved near infrared spectroscopy (TRS) while acquiring ¹⁵O-water PET scans at baseline, after injection of acetazolamide and during induced hypoxic episodes. BFI by DCS was highly correlated with rCBF (R = 0.94, p < 0.001) by PET. A scaling factor of 0.89 (limits of agreement for individual measurement: 0.56, 1.39)×10⁹× (ml/100g/min)/(cm²/s) was used to derive baseline rCBF from baseline BFI measurements of another group of piglets and of healthy newborn infants showing an agreement with expected values. These results pave the way towards non-invasive, cot-side absolute CBF measurements by DCS on neonates.     

Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis

Background and purpose

Placement of flow-diverters across the ostia of major ICA branches carries a risk of arterial occlusion. We determined the rate of occlusion of the supraclinoid ICA branches and the related symptoms, following coverage with flow-diverters.