The effectiveness of a golf injury prevention program (GRIPP intervention) compared to the usual warm-up in Dutch golfers: protocol design of a randomized controlled trial.

BACKGROUND: Sixty million golfers around the world play golf. Golf injuries are most frequently located in the spine, elbow, wrist, hand and shoulder. Those injuries are often seen in golfers with more playing hours and suboptimal swing biomechanics, resulting in overuse injuries. Golfers who do not perform a warm-up or do not warm-up appropriately are more likely to report an injury than those who do. There are several ways to warm-up. It is unclear, which warm-up is most useful for a golfer to perform. Moreover, there is currently no evidence for the effectiveness of a warm-up program for golf injury prevention. We previously have developed the Golf Related Injury Prevention Program (GRIPP) intervention using the Knowledge Transfer Scheme (KTS). We aim to evaluate the effect of the GRIPP intervention on golf-related injuries. The hypothesis is that the GRIPP intervention program will reduce the number of golf-related injuries. METHODS AND DESIGN: The GRIPP study is a two-armed randomized controlled trial. Twenty-eight golf clubs with 11 golfers per club will be randomly allocated to the intervention or control group. The intervention group will perform the GRIPP intervention program, and the control group will perform their warm-up as usual. The GRIPP intervention is conducted with the Knowledge Transfer Scheme framework, which is a systematic process to develop an intervention. The intervention consists of 6 exercises with a maximum total of 10 min. The primary outcome is the overall prevalence (%) of golf injuries measured with the Oslo Sports Trauma Research Center (OSTRC-H) questions on health problems every fortnight. The secondary outcome measures will be exposure to golf and compliance to the intervention program. DISCUSSION: In other sports warm-up prevention programs are effective in reducing the risk of injuries. There are no randomized trials on golf injury prevention. Therefore, an individual unsupervised golf athlete intervention program is conducted which reflects the daily practice of predominantly unsupervised exposure of amateur golfers. TRIAL REGISTRATION: The trial is retrospectively (28 October 2021) registered at the Dutch Trial Register: NL9847 ( https://trialsearch.who.int ).

[Influence of early childhood stress exposure and traumatic life events on pain perception]. / Einfluss frühkindlicher Stresserfahrungen und traumatisierender Lebensereignisse auf das Schmerzempfinden.

Adult pain perception is influenced substantially by interactions between mind, body, and social environment during early life. Early stress exposure and traumatic life events induce powerful psychophysical stress reactions that exert multiple neurofunctional processes. This has significant implications for pain perception and pain processing. As part of this review, the complex relationships between traumatic stress experiences and associated psychobiological mechanisms of chronic pain will be discussed. Based on selected studies, psychophysiological findings are presented and possible underlying mechanisms are discussed. The article concludes with a discussion of potential implications for treatment.

Biofouling resistance of boron-doped diamond neural stimulation electrodes is superior to titanium nitride electrodes in vivo.

OBJECTIVE: The goal of this study was to assess the electrochemical properties of boron-doped diamond (BDD) electrodes in relation to conventional titanium nitride (TiN) electrodes through in vitro and in vivo measurements. APPROACH: Electrochemical impedance spectroscopy, cyclic voltammetry and voltage transient (VT) measurements were performed in vitro after immersion in a 5% albumin solution and in vivo after subcutaneous implantation in rats for 6 weeks. MAIN RESULTS: In contrast to the TiN electrodes, the capacitance of the BDD electrodes was not significantly reduced in albumin solution. Furthermore, BDD electrodes displayed a decrease in the VTs and an increase in the pulsing capacitances immediately upon implantation, which remained stable throughout the whole implantation period, whereas the opposite was the case for the TiN electrodes. SIGNIFICANCE: These results reveal that BDD electrodes possess a superior biofouling resistance, which provides significantly stable electrochemical properties both in protein solution as well as in vivo compared to TiN electrodes.

[Childhood abuse experiences and chronic low back pain. Direct and mediated effects of childhood abuse in different pain dimensions of nonspecific chronic low back pain]. / Frühe Missbrauchserlebnisse bei chronischem Kreuzschmerz. Direkte und mediierte Effekte früher Missbrauchserlebnisse auf verschiedene Schmerzdimensionen chronischer nichtspezifischer Kreuzschmerzen.

BACKGROUND: Physical, sexual and emotional abuse in childhood and adolescence is considered to play a role in the etiology and generalization of chronic pain in adulthood. However, it remains unclear whether abuse is specifically associated with different dimensions of nonspecific chronic low back pain (CLBP) and if these associations are mediated by psychological symptoms. MATERIAL AND METHODS: A total of 103 patients with validated CLBP were assessed by pain drawing, the multidimensional pain questionnaire and the pain experience scale. The childhood trauma questionnaire was used to retrospectively screen for physical, sexual and emotional abuse in childhood and adolescence. Patients were also screened for symptoms of depression, anxiety and dissociation in order to look for possible mediators. RESULTS: Patients with CLBP who reported childhood abuse showed higher pain intensity, higher spatial extent of pain, higher affective and sensory pain sensation and more pain disability compared to CLBP patients who had not experienced abuse. However, multivariate analyses revealed that only the spatial extent of pain was directly associated with childhood abuse. Furthermore, a significant association between childhood abuse and sensory pain sensation was found to be mediated by symptoms of anxiety and dissociation. CONCLUSION: The influence of childhood abuse on CLBP is different for specific pain dimensions; therefore, CLBP should be faced as a complex construct that comprises different dimensions. Childhood abuse is suggested as a risk factor for spreading pain in CLBP persons; therefore, CLBP patients reporting additional pain locations might benefit from diagnostic and therapeutic interventions specific for childhood abuse experiences.

Early related or unrelated haematopoietic cell transplantation results in higher overall survival and leukaemia-free survival compared with conventional chemotherapy in high-risk acute myeloid leukaemia patients in first complete remission.

Between 1996 and 2004, a total of 708 patients were enrolled in the acute myeloid leukaemia (AML) '96 and '02 studies of the East German Study Group (OSHO). Of these, 138 patients (19.5%) had unfavourable cytogenetics defined as complex karyotype, del (5q)/-5, del (7q)/-7, abn (3q26) and abn (11q23). In all, 77 (56%) achieved complete remission 1 (CR1) after induction chemotherapy and were eligible for haematopoietic cell transplantation (HCT). HCT was performed after a median of two cycles of consolidation chemotherapy (CT) in the AML '96 and one cycle in the AML '02 study (P=0.03). After a median follow-up of 19 months, overall survival (OS) at two years was significantly better in the donor group (52+/-9%) versus the no-donor group (24+/-8%; P=0.005). Differences in outcomes were mainly because of a lower relapse incidence in patients after HCT (39+/-11%) compared with a higher relapse incidence in patients undergoing CT (77+/-10%; P=0.0005). Treatment-related mortality was low and not statistically significantly different between the two treatment groups (15+/-7 and 5+/-5% for HCT and chemotherapy, respectively; P=0.49).We conclude that early HCT from related or unrelated donors led to significantly better OS and leukaemia-free survival compared with chemotherapy in patients with unfavourable karyotype.

[Thrombophilia in pregnancy: venous thromboembolism, fetal loss, preeclampsia, intrauterine growth restriction]. / Thrombophile Hämostasestörung in der Schwangerschaft: Thrombose, Abort, Präeklampsie, intrauterine Wachstumsretardierung.

Women with acquired and hereditary thrombophilia are at increased risk of developing venous thromboembolism and other associated gestational vascular complications like fetal loss, preeclampsia, intrauterine growth restriction, and placental abruption during pregnancy. These complications are a major cause of maternal and fetal morbidity and mortality. In view of the data showing an association between thrombophilia and these adverse pregnancy outcomes, clinicians are increasingly using antithrombotic therapy in women at risk of these complications. Aside from recurrent pregnancy loss in antiphospholipid syndrome and prevention of venous thromboembolism, there is limited evidence on the benefit of antithrombotic interventions to guide therapy. The data in favour of antithrombotic therapy in women with hereditable thrombophilia and vascular placental complications consist predominantly of small uncontrolled trials or observational studies. Randomized, placebo-controlled trials are lacking as most patients do not accept placebo. Further randomised controlled trials are urgently required to explore this therapeutic option.

Phytoassessment of acid mine drainage: Lemna gibba bioassay and diatom community structure.

An integrated multilevel phytoassessment of an acid mine drainage (AMD, pH range 3.3-6.8) in southern Portugal was performed. A 7-day phytotoxicity bioassay with the duckweed Lemna gibba (chlorosis, necrosis, growth) was carried out, both in the laboratory and in situ, combined with an analysis of the resident epilithic diatom community. The toxicity test was performed with water from the AMD gradient, an unpolluted river control and acidified control water, in order to discriminate potential pH-effects from combined pH- and metal-effects. Diatom communities discriminated well among the sites (alkalophilic species versus halobiontic, acidobiontic and acidophilic species), showing inter-site differences to be larger than intra-site seasonal variations. In L. gibba exposed to AMD, necrosis and growth inhibition were higher in situ compared to the laboratory experiments. L. gibba was more sensitive to AMD than to acidified water. Already after 4 days, growth rate inhibition in L. gibba proved to be a reliable indicator of AMD-stress. Ecotoxicological thresholds obtained with L. gibba corresponded with those obtained previously with animals of intermediate tolerance to AMD. The results were summarised in a multimetric index.

[Pregnancy-associated venous thromboembolic disease: prediction, prevention, and therapy]. / Venöse Thrombose in der Schwangerschaft. Prädiktion, Prävention und Therapie.

Thromboembolic disease remains a leading cause of maternal mortality during pregnancy and the puerperium. Rational and risk-adapted administration of heparin prophylaxis depends on 1. the identification of those women who have an increased risk of thrombosis and 2. the accurate quantification of this risk. In women without prior thrombosis, the presence of a heterozygous factor V Leiden or heterozygous G20210A mutation in the prothrombin gene is associated with a pregnancy-associated thrombotic risk of approximately 1 in 400. Thus, in pregnant carriers of either one of these mutations the risk of venous thromboembolism is low. Therefore, no heparin prophylaxis is recommended. A combination of the two genetic risk factors can increase the risk to a modest level of 1 in 25. In women with a single episode of prior thrombosis associated with a transient risk factor, e.g. surgery or trauma, and no additional genetic risk factor, the probability of a pregnancy-associated thrombosis appears also to be low. However, data are sparse and conflicting. In contrast, in women with a prior idiopathic venous thrombosis who carry an additional hereditary risk factor or who have a positive family history of thrombosis, a high risk (>10%) can be expected supporting the indication for active antepartum and postpartum heparin prophylaxis. Despite the remarkable progress in risk stratification, the absolute magnitude of risk and the optimal management in many cases is an issue of ongoing debate.

Effects of acid mine drainage and acidity on the activity of Choroterpes picteti (Ephemeroptera: Leptophlebiidae).

Survival and behavior of the mayfly Choroterpes picteti (Leptophlebiidae) exposed to acid mine drainage (AMD: pH 3.3-6.4) and a reservoir polluted with arsenic (pH 6.8) from Sao Domingos mine (Portugal) were studied in laboratory and in situ bioassays (48 h) with the Multispecies Freshwater Biomonitor, and compared with water from a reference river and acidified reference water (acid only). Metal body-burdens showed a negative pH dependency for Mn and As, a positive one for Pb, and for Zn, Cu, Co, and Cd a decrease at pH < 4.4. Generally, survival decreased with decreasing pH. The 48-h LC(50) (pH) for AMD and for acid only were similar (pH 4.8-4.9); however, the LT(20) (h) at pH 3.3 revealed AMD to be less toxic than acid only. C. picteti show diurnal rhythm with increased locomotor activity in the night. The circadian rhythm was weakened by acid exposure, but less so by AMD exposure. Compared to reference river water, ventilation was stimulated at pH < 6.0 in acid only and in reservoir water. Locomotion was stimulated at pH 5 in acid only and reservoir; however, it was reduced in all other treatments, when compared to reference river water. Under acid-only exposure, both locomotion and ventilation were significantly higher compared to AMD exposure at the corresponding pH values. The laboratory results were field validated.

The G20210A prothrombin-gene mutation and the plasminogen activator inhibitor (PAI-1) 5G/5G genotype are associated with early onset of severe preeclampsia.

Hereditary risk determinants of venous thrombosis have been reported to be associated with severe preeclampsia. So far there are no data to support whether these risk determinants are related to the time of onset of severe preeclampsia. We used a case-control design, studying 97 women with severe preeclampsia in previous pregnancies and 277 normal women, to assess hereditary risk factors of venous thrombosis as risk determinants for severe preeclampsia. A case-only design comprising solely the 97 women with a history of preeclampsia was used to evaluate these risk factors as risk determinants for early onset of severe preeclampsia. Using the case-control design, there was no significant risk association of the hereditary risk factors with severe preeclampsia [factor V Leiden, odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4, 2.2; prothrombin mutation, OR 1.9, 95% CI 0.5, 7.0; methylentetrahydrofolate reductase 677TT genotype, OR 0.8, 95% CI 0.4, 1.8; plasminogen activator inhibitor (PAI-1) 4G/4G genotype, OR 1.2, 95% CI 0.7, 2.1; PAI-1 5G/5G genotype, OR 1.0, 95% CI 0.5, 1.8]. However, the onset of severe preeclampsia was significantly earlier in women with the G20210A prothrombin gene mutation (24.5 weeks vs. 30.1 weeks, P = 0.046) and in women with the PAI-1 5G/5G genotype (25.7 weeks vs. 30.8 weeks, P = 0.024). Hereditary risk factors for venous thrombosis do not predispose for severe preeclampsia. However, women who are carriers of the G20210A prothrombin gene mutation and the PAI-1 5G/5G genotype are at risk for early onset of severe preeclampsia. It appears that these risk factors do not induce the pathomechanism but accelerate the course of preeclampsia.

Macroinvertebrate response to acid mine drainage: community metrics and on-line behavioural toxicity bioassay.

The hypothesis is tested that toxicity of acid mine drainage can be detected by a selection of existing macroinvertebrate community and bioindicator metrices supplemented by toxicity tests with the local mosquitofish Gambusia holbrooki Girard and the shrimp Atyaephyra desmaresti Millet. The behavioural responses of A. desmaresti to acid mine drainage were recorded in the Multispecies Freshwater Biomonitor, based on behaviour and survival as parameters. Bioassessment methods were based on community diversity, structure, function, and bioindicators and supplemented by chemical analysis (temperature, pH, metals). The Biological Monitoring Working Party adapted for the Iberian Peninsula, the number of predators (Coleoptera, Hemiptera) and the number of Ephemeroptera and Trichoptera taxa differentiated the sites well. The on-line toxicity test revealed pH-dependent acute toxicity of the acid mine drainage for the shrimp (LC(50)-48 h: pH-AMD=5.8) and a pH- dependent decrease in locomotory activity with the lowest-observed-response-times (LORTs) within 5 h of exposure. Shrimp were more sensitive to acid mine drainage than fish (LC(50)-48 h: pH-AMD=4.9). A new multimetric index combining toxicity testing and bioassessment methods is proposed.

Immunocytological confirmation of bone marrow metastases in a dog with cholangiocarcinoma.

The case history of a four-year-old, male Bernese mountain dog is presented. Carcinoma cells were detected in the liver by ultrasound-guided fine-needle aspiration. Bone marrow aspirated from the iliac crest and the left femur showed a distinct infiltration by carcinoma cells. Immunocytological examination of the liver and bone marrow metastases showed a negative staining result for large spectrum cytokeratin (CK) KL1, a strong positive result for CK7 and a focal weak positive result for CK20. The dog was euthanased due to the grave prognosis. Histopathological examination revealed metastatic cholangiocarcinoma. The authors conclude that cytological and immunocytological examination of bone marrow aspirates should be used more frequently for the detection of distant metastases of carcinomas in small animal medicine.

Seroreactivity against MAGE-A and LAGE-1 proteins in melanoma patients.

BACKGROUND: Cancer-testis antigens exemplify a growing number of tumour antigens which are expressed in a variety of malignancies, but not in normal tissues other than germ cells, primarily those of the testis. OBJECTIVES: To investigate the humoral response to known cancer-testis antigens in melanoma patients. METHODS: We used phage clones coding for seven different melanoma antigens MAGE-A or LAGE-1A proteins. These clones were isolated using the newly developed DNA hybridization analysis of recombinantly expressed cDNA libraries (HYREX) approach. HYREX combines the advantage of a nonradioactive library screening method with the possibility of subsequently analysing the serological response to the recombinant proteins. We isolated clones coding for MAGE-A1, -A3, -A4b, -A6, -A9 and -A12, as well as LAGE-1A. Additionally, we correlated gene expression and seroreactivity. RESULTS: Between 13% and 27% of sera (n = 15) were reactive against individual tumour antigens. We found the presence of specific antibodies was, with only two exceptions, generally correlated with mRNA expression of the antigen within cell lines derived from the same patient. While cross-reactivity of patients' IgG might play a role in these cases, antibodies from patients' sera were able to distinguish even the closely related MAGE-A3 and -A6. In general, the mRNA expression frequency was higher than the detected IgG responses. CONCLUSIONS: Antibody recognition of specific tumour antigens by patients' sera may be used for evaluating the possible immunogenicity of new antigens; serological tests could be used for tumour monitoring purposes.