Return to sport and beyond following intramuscular tendon hamstring injury: A case report of an English Premier League football player.

BACKGROUND: Hamstring strain injuries are the most common type of injury in elite football and are associated with a high risk of reinjury, particularly those involving the intramuscular tendon (IMT). Limited information is available regarding the rehabilitation and return to sport (RTS) processes following such injuries. This case study describes the clinical presentation of an elite football player following IMT hamstring injury, their on- and off-pitch rehabilitation alongside performance monitoring throughout RTS and beyond. CASE SCENARIO: An elite football player suffered a grade 2c hamstring injury during an English Premier League (EPL) match. The player underwent early post-injury management, alongside progressive off-pitch physical preparation. The 'control-chaos continuum' was used as a framework for on-pitch rehabilitation to prepare the player for a return to full team training and competition. Objective and subjective markers of the player's response to progressive on- and off-pitch loading were monitored throughout RTS and beyond. OUTCOMES: The player returned to on-pitch rehabilitation after 11 days, to full team training having achieved weekly pre-injury chronic running load outputs after 35 days and played in the EPL 40 days post-injury. The player did not suffer reinjury for the rest of the EPL season. CONCLUSION: An understanding the unique structural and mechanical properties of the IMT, alongside expected RTS timeframes are important to inform rehabilitation and decision-making processes post-injury. Performance and frequent load-response monitoring throughout RTS and beyond, in conjunction with practitioner experience and effective communication are critical in facilitating effective RTS and reduce risk of reinjury following IMT injury.

Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning.

The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.

Drill design using the 'control-chaos continuum': Blending science and art during return to sport following knee injury in elite football.

Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The 'control-chaos continuum' (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.

Sedación paliativa: situación actual y áreas de mejora / Palliative sedation: current situation and areas of improvement

Objetivo. Conocer la prevalencia, las características epidemiológicas y la calidad del registro relativos a la sedación paliativa (SP) en un hospital universitario. Establecer áreas de mejora. Material y método. nálisis descriptivo retrospectivo de los registros clínicos de pacientes oncológicos fallecidos en nuestro centro entre octubre y diciembre de 2010. Las variables analizadas incluyeron: datos epidemiológicos y ubicación de los pacientes, presencia de SP, síntoma que la motivó, grado de participación del paciente y la familia en la toma de decisiones, fármacos y dosis utilizados. El análisis cualitativo se desarrolló mediante 2 rondas Delphi en las que cada participante recibió los resultados globales del grupo. Fueron seleccionados aquellos ítems en los que existía un consenso completo o elevado. Resultados. Identificamos 53 defunciones por cáncer, el 51% recibieron SP. La edad media fue de 67 años, y el 64% fueron varones. El cáncer de pulmón supuso el 32%. Quince pacientes dependían de Oncología, 7 de Hematología y 4 del Servicio de Urgencias. En el 53,85% existió intervención de cuidados paliativos. Los síntomas que motivaron la SP fueron: disnea en 11 casos y delirium en 5. El tiempo medio ingreso-SP fue de 9,5 días (duración media, 1,2 días). La media de fármacos utilizados fue de 2,6, con empleo de morfina en el 100% y midazolam en el 98%. En 20 casos constatamos el registro de consentimiento para su inicio (100% verbal). Doce profesionales participaron en el análisis cualitativo fruto del cual consensuamos una plantilla para mejorar los registros de selección, toma de decisiones y evolución en los casos de SP. Conclusiones. La SP fue motivada por disnea o delirium y se aplicó en la mitad de los pacientes fallecidos. Las áreas de mejora detectadas afectaban al registro de los criterios de selección, al tipo de sedación y a la participación del paciente en la toma de decisiones. Por ello hemos consensuado un conjunto mínimo de datos que facilitará la recogida de información de los profesionales (AU)

Objective. To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. Methods. A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. Results. A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. Conclusions. PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS (AU)

[Palliative sedation: Current situation and areas of improvement]. / Sedación paliativa: situación actual y áreas de mejora.

OBJECTIVE: To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. METHODS: A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. RESULTS: A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. CONCLUSIONS: PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS.

Overlapping gene expression profiles in rheumatoid fibroblast-like synoviocytes induced by the proinflammatory cytokines interleukin-1 beta and tumor necrosis factor.

OBJECTIVE AND DESIGN: The development of therapies directed against TNF alpha and IL-1 beta has underscored the importance of these cytokines in rheumatoid arthritis (RA). In this study, oligonucleotide microarrays were used to identify novel transcriptional events mediated by TNF alpha and IL-1 beta. METHODS: In this study we have used Affymetrix U95A GeneChips representing 12,600 full-length human genes to identify transcriptional events mediated by these cytokines. Fibroblast-like synoviocytes were cultured from rheumatoid synovium from RA patients and stimulated with TNF alpha and IL-1 beta. Gene transcript levels were determined using Affymetrix U95A GeneChips representing 12,600 full-length human genes. RESULTS: A large number of differentially regulated genes were identified (1.7% of array-displayed genes for TNF alpha and 2.4% for IL-1 beta), and the validity of the array protocol was subsequently confirmed using real-time PCR. The majority of the differentially expressed genes were regulated by both TNF alpha and IL-1 beta, reflecting the distal signaling pathways shared by these cytokines. A large number of novel TNF alpha and IL-1 beta-regulated genes were identified. CONCLUSIONS: A panel of novel TNF alpha- and IL-1 beta-regulated genes was identified, and these are promising candidates for further study in relation to RA and other inflammatory diseases.

Modification of hormonal responses to arginine by alpha-adrenergic blockade.

alpha-Adrenergic blockade with phentolamine significantly enhances the insulin response to arginine. In women phentolamine may inhibit the growth hormone response to arginine. It is suggested that adrenergic mechanisms may act as modulators in hormonal responses to infused amino-acid.