Neuromuscular training for the prevention of ankle sprains in female athletes: a systematic review.

Ankle sprains are a common sports-related injury, and female athletes are more likely to sustain this injury than their male counterparts. Previous reviews have evaluated the efficacy of prevention programs in reducing ankle sprains in athletes, but no reviews have specifically focused on female athletes. The objective of this systematic review was to examine the sex-specific effectiveness of neuromuscular training (NMT) programs in reducing the risk of ankle sprains in female athletes. A search of PubMed, Ovid Medline, Embase, and Web of Science databases was performed using the terms: (proprioception OR proprioceptive OR balance OR neuromuscular OR stability OR sensorimotor) AND training AND (ankle sprain OR ankle injury OR inversion injury OR ankle instability) AND (sport* OR athlet* or basketball OR volleyball OR soccer OR handball OR tennis OR netball OR hockey OR softball OR gymnastics OR danc* OR ballet OR cheerlead*) AND (female OR women OR girl). Studies selected for inclusion were written in English, evaluated female athletes in organized athletics or reported female-specific data for mixed-sex cohorts, included a non-NMT comparison, and used ankle injury rate outcome measures. Seven articles were selected for inclusion, which evaluated a combined 5,187 female basketball, handball, volleyball, soccer, and floorball players. Two studies reported significant differences between NMT participants and controls, concluding the greatest effects were observed in preventing non-contact ankle sprains. The remaining 5 studies, although not statistically significant, revealed an evident trend toward the efficacy of ankle injury prevention with NMT programs. Current available evidence supports the efficacy of NMT in preventing ankle sprains in female athletes. When designing NMT programs, investigators should consider utilizing comprehensive approaches that incorporate strength, balance, plyometric, and agility training as the studies with significant findings created comprehensive NMT programs. Further investigations into sport- and female-specific programs are warranted.

Donor Lymphocyte Infusions Used to Treat Mixed-Chimeric and High-Risk Patient Populations in the Relapsed and Nonrelapsed Settings after Allogeneic Transplantation for Hematologic Malignancies Are Associated with High Five-Year Survival if Persistent Full Donor Chimerism Is Obtained or Maintained.

Mixed chimerism (MC), a persistent or increasing number of host cells after allogeneic hematopoietic stem cell transplantation (HSCT), is a predictor of disease relapse. Donor lymphocyte infusions (DLI) have the potential to enhance the graft-versus-malignancy (GVM) effect, reducing the risk of relapse in patients with MC. Hence, in addition to utilizing DLI in the relapsed setting, there is a motivation to pursue pre-emptive DLI for patients in complete remissions after HSCT. To assess the safety and efficacy of DLI, records of 86 patients who received DLI between 2003 and 2015 at a single institution were studied retrospectively. Patients who received DLI included 50 patients with relapsed/residual (RR) disease, 29 patients with emerging MC without detectable disease, and 7 patients in an "other" cohort who had neither RR disease nor emerging MC after HSCT. DLI were administered using a dose-escalation protocol. After DLI, 93% of MC patients converted to full donor chimerism (FDC). Nonrelapsed patients (MC and other) reported high overall survival (OS) at 1 and 5 years (83% at 1 year, 70% at 5 years for MC; 86% at 1 year, 69% at 5 years for other) and was statistically superior to 5-year OS for RR patients (nonrelapsed 69% versus RR 28%; P = .00032). Improved survival correlated with successful conversion to FDC after DLI for RR and MC cohorts: 71% 2-year OS for patients converted to FDC versus 13% for patients who failed to achieve FDC (P < .0001). DLI for nonrelapsed patients was associated with a superior 5-year progression-free survival (PFS) of 71% compared with 18% 5-year PFS in the RR group (P < .0001). Relapse/progressive disease was the most frequent cause of death (41%). Seven MC (24%), 2 other (29%), and 39 RR patients (78%) relapsed or did not respond after DLI. Overall, 6 patients (7%) died of graft-versus-host disease after DLI. Our results demonstrate a successful dose-escalation approach for nonrelapsed patients that correlated with high survival and a high rate of achieving FDC in MC and RR populations. DLI remain a viable option to boost the GVM effect in the relapsed setting and may pre-emptively protect against relapse in MC populations after HSCT.