Oxidative conversion of lignin isolated from wheat straw into aromatic compound catalyzed by NaOH/NaAlO2.

Lignin was isolated from wheat straw via organosolv process and further transferred to monophenolic compounds via oxidative conversion. Wheat straw lignin (WSL) with purity at 91.4 wt% was acquired in the presence of heterogeneous and recyclable catalyst of Amberlyst-45. WSL was characterized by infrared spectrometer (IR), nuclear magnetic resonance spectroscopy (NMR) including 1H NMR and 13C NMR spectra. The results showed that WSL possesses typical syringyl (S), guaiacyl (G), and p-hydroxyphenyl (H) units, and it is mainly composed of S and G units. The product distribution was dependent on the composition of WSL. Derivatives from S and G units were found to be the main products. The oxidative conversion of WSL was performed by varying oxidant and catalyst. Both the formation of monophenolic compounds and aromatic aldehydes were enhanced by combining oxidants and catalysts. The composite catalyst composed of NaOH/NaAlO2 was effective for the oxidation of WSL in the presence of nitrobenzene and atmospheric pressure air. The total yield of monophenolic compounds reached up 18.1%, and yields at 6.3 and 5.7% for syringaldehyde and vanillin were achieved, respectively.

Musculoskeletal Anatomy Knowledge Retention in the Macquarie University Chiropractic Program: A Cross-Sectional Study.

Attrition of anatomy knowledge has been an area of concern in health professions curricula. To ensure safe and effective clinical practice, the study of chiropractic requires a good knowledge of musculoskeletal anatomy. In this study, musculoskeletal limb knowledge retention was investigated among students in the 5-year chiropractic program at Macquarie University, Australia. A test of 20 multiple-choice questions, categorized into low-order (LO) and high-order (HO) cognitive ability according to Bloom's Taxonomy, was developed. Students enrolled in the program were invited to participate with 257 of the 387 choosing to participate, (response rate ranging 56%-72% per year level). No attrition of knowledge across the years was observed, instead, a significant increase in knowledge, measured by total LO and HO scores (P < 0.0005), throughout the program. There were significant increases in both low and high cognitive scores which were not uniform, with high-order scores increasing significantly in the last two year levels. The increase of knowledge, may be explained, at least partially, by the vertical and horizontal integrated curriculum. Retrieval of knowledge, especially in clinically applied formats, may have led to an enhanced ability to apply anatomy knowledge and account for the increased scores in the high-order knowledge seen in the later clinical years. Evaluating anatomy knowledge retention at different cognitive levels seems to provide a better assessment and is worth considering in future anatomy educational research.

Factors Affecting Corneal Organ Culture Contamination: A 6-year Study at the New South Wales Tissue Bank.

PURPOSE: To report the rate of microbial contamination and analyze possible risk factors for contamination of banked corneas stored using the organ culture method. METHODS: Data from the New South Wales Tissue Banks incorporating the Lions NSW Eye Bank, between September 1, 2011, and November 30, 2017, were reviewed retrospectively. All corneas collected during this period and stored in organ culture storage media were tested for microbial contamination. The influence of potential factors on the rate of contamination was analyzed using the χ test and logistic regression using generalized estimating equations. RESULTS: A total of 4410 corneas were included in this study, of which 110 were medium culture positive, representing a microbial contamination rate of 2.5%. The main contaminants were Candida species followed by Staphylococcus species. Corneal tissue collected in summer and autumn had a significantly higher contamination rate (P = 0.006). All other factors studied were not shown to have a statistically significant association with contamination after accounting for within-pair correlation and confounders. CONCLUSIONS: A relatively low contamination rate of 2.5% observed in our study reflects the stringent laboratory protocols, strict donor selection criteria, and high level of experience among staff at the Lions NSW Eye Bank. Our study demonstrated that the season of collection had a strong association with the rate of organ culture contamination. Because Candida species contributed the largest percentage of contamination, specific measures to reduce and eliminate fungal proliferation should be considered by eye banks particularly in warm seasons.

The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: A meta-analysis.

OBJECTIVES: Chronic subdural hematoma (cSDH) is a common neurological disorder in elderly and the immediate outcome of surgery is satisfied. The high reoperation rate hinders the long-term effect of surgery and the risk factor is still unclear. Some researchers reported that high recurrence rate is related to the antithrombotic (AT) drugs, which is commonly used to prevent diseases in elderly patients. In this article, we conducted a meta-analysis to determine whether AT agents increase the risk of recurrence and mortality in patients with cSDH. METHODS: The human case-control or randomized controlled trial (RCT) studies regarding the association of cSDH and AT were systematically identified through online databases (PubMed, Cochrane, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated. RESULTS: This meta-analysis included 24 studies. AT drugs significantly increased the risk of recurrence in patients with cSDH (odds ratio (OR) of 1.30, 95% confidence interval (CI), 1.11-1.52, P = .001). Further analysis demonstrated that both anticoagulation (OR of 1.41, 95% CI, 1.10-1.81, P = .006) and antiplatelet (OR of 1.23, 95% CI, 1.01-1.49, P = .03) had higher risk of recurrence, but no difference was found between them (OR of 0.80, 95% CI, 0.58-1.09, P = .16). However AT drugs did not increase the risk of mortality for patients with cSDH (OR of 1.08, 95% CI, 0.61-1.92, P = .78). CONCLUSION: AT treatment is an important risk factor of recurrence in patients with cSDH in spite of similar mortality rate. When and how to resume AT drugs is still unclear, more well-designed prospective researches are needed on this issue. CORE TIP: High recurrence is an important factor against the long-term outcome of surgery in patients with cSDH, the use of AT drugs is a potential risk factor. In this study we found that the use of AT drugs increased the risk of recurrence rather than mortality. Anticoagulation and antiplatelet showed no difference in causing cSDH recurrence.

Australian osteopathic practitioners' perceptions of the clinical relevance of anatomy / Percepciones de los practicantes de osteopatía australianos de la relevancia clínica de la anatomía

SUMMARY: Anatomy is a foundational discipline in the training of health care professionals. However, there is a paucity of literature on the relative importance of anatomy, especially in relation to the other biomedical sciences and clinical domains, in preparing osteopathic practitioners for clinical practice. This study aimed to examine Australian osteopathic practitioners' perceptions of the relative importance of anatomy in their professional training and clinical practice, especially in relation to other biomedical sciences and clinical domains within osteopathic curricula. The study also examined the perceived importance of the sub-disciplines of anatomy to professional practice. A questionnaire-based survey was carried out among Australian osteopathic practitioners at several national meetings in 2014 and 2015. Using a five-point Likert scale, all respondents were asked to rate the relevance of the following thirteen disciplines and subdisciplines to clinical practice: biomechanics, biochemistry, embryology, histology, gross anatomy, microbiology, neuroanatomy, neurology, pathology, pharmacology, physical examination, physiology and radiology. Out of 175 practitioners surveyed, 169 responded (i.e., 96.6 % response rate). Two of the sub-disciplines of anatomy were among the highest rated, with 98.2 % perceiving gross anatomy as "very important" while neuroanatomy being rated as "very important" by 84.6 % and "quite important" by 14.2 %. Similar high rating was also given to biomechanics and physical examination while the other two sub-disciplines, embryology and histology received lower ratings. No significant difference in ratings were identified with regard to participants' year and place of graduation. However, there was an association between gender and rating on Pathology and Pharmacology respectively, as well as age effects on the ratings of several sub-disciplines. These findings are generally consistent with the results from similar surveys carried out on the clinical importance of anatomy in other medical and allied health professionals in different countries. Overall, osteopathic practitioners have a positive perception of the relevance of anatomy, particularly gross and neuroanatomy, to clinical practice, and this should be taken into account when developing osteopathic curricula.

RESUMEN: La anatomía es una disciplina fundamental en la formación de profesionales de la salud. Sin embargo, hay poca literatura sobre la importancia relativa de la anatomía, especialmente en relación con las otras ciencias biomédicas y los dominios clínicos, en la preparación de profesionales de la osteopatía para la práctica clínica. Este estudio tuvo como objetivo examinar las percepciones de los médicos osteopáticos australianos sobre la importancia relativa de la anatomía en su formación profesional y práctica clínica, especialmente en relación con otras ciencias biomédicas y dominios clínicos dentro de los currículos osteopáticos. El estudio también examinó la importancia percibida de las subdisciplinas de la anatomía para la práctica profesional. Se realizó una encuesta basada en un cuestionario entre los profesionales osteopáticos australianos en varias reuniones nacionales en 2014 y 2015. Utilizando una escala Likert de cinco puntos, se pidió a todos los encuestados que calificaran la relevancia de las siguientes trece disciplinas y subdisciplinas para la práctica clínica: Biomecánica, bioquímica, embriología, histología, anatomía macroscópica, microbiología, neuroanatomía, neurología, patología, farmacología, exploración física, fisiología y radiología. De los 175 practicantes encuestados, 169 respondieron (es decir, una tasa de respuesta del 96,6 %). Dos de las subdisciplinas de la anatomía estaban entre las mejor calificadas, con un 98,2 % que percibían la anatomía general como "muy importante", mientras que la neuroanatomía se calificaba como "muy importante" en un 84,6 % y "muy importante" en un 14,2 %. También se dio una calificación alta similar a la biomecánica y el examen físico, mientras que las otras dos subdisciplinas, embriología e histología recibieron calificaciones más bajas. No se identificaron diferencias significativas en las calificaciones con respecto al año de los participantes y el lugar de graduación. Sin embargo, hubo una asociación entre el sexo y la calificación en Patología y Farmacología respectivamente, así como los efectos de la edad en las calificaciones de varias subdisciplinas. Estos hallazgos son generalmente consistentes con los resultados de encuestas similares realizadas sobre la importancia clínica de la anatomía, en otros profesionales de la salud médicos y afines en diferentes países. En general, los profesionales de la osteopatía tienen una percepción positiva de la relevancia de la anatomía, en particular la neuroanatomía general y la neuroanatomía, para la práctica clínica, lo que se debe tener en cuenta al desarrollar los currículos osteopáticos.

Students' perceptions and usage of short anatomy videos: a preliminary study / Percepciones de los estudiantes y el uso de videos cortos de anatomía: un estudio preliminar

The efficacy of videos in anatomy education is still being debated. It appears that one of the major factors discouraging learners to use videos has been their length. To counteract this, 24 short videos (the longest lasting 1 minute and 13 seconds), were created for a course on musculoskeletal anatomy. Videos focused on identification of muscles of the limbs and their relations by area. The aim of this preliminary study was to assess students' perception of value of the videos and their utilisation. The number of views for each video was recorded. A questionnaire based survey was carried out focusing on students' perception of the educational usefulness of the videos. On average, each video had 339.5 views. Out of 312 students enrolled in the course, 210 completed the survey (67.3 % response rate). A total of 181 respondents (86.2 %) watched the videos and a majority perceived them useful in: Learning about the anatomy of the limbs (68 %), preparation for the laboratory (56.9 %), post-laboratory revision (65.6 %) and preparation for the practical test (66.3 %). Asked for feedback, students requested an increase in the number of videos to include structures other than muscles. Students reported to perceive videos as a useful resource in their musculoskeletal anatomy course. The shortness of the videos made them easy to access and use repeatedly. Future, more in-depth studies, based on the utilisation of the existing and newly produced videos, might throw more light on their full educational potential.

Actualmente, aún se está debatiendo la eficacia de los videos en la educación de la anatomía. Posiblemente, uno de los principales factores que desalientan a los estudiantes a usar videos ha sido el tiempo de duración. Para contrarrestar esto, se crearon 24 videos cortos (el más duradero de 1 minuto y 13 segundos) para un curso sobre anatomía musculoesquelética. Los videos se enfocaron en la identificación de los músculos de los miembros y sus relaciones por área. El objetivo de este estudio preliminar fue evaluar la percepción de los estudiantes sobre el valor de los videos y su utilización. Se registró el número de visitas para cada video. Se llevó a cabo una encuesta basada en cuestionarios que se centraron en la percepción de los estudiantes de la utilidad educativa de los videos. En promedio, cada video tuvo 339,5 visitas. De los 312 estudiantes matriculados en el curso, 210 completaron la encuesta (67,3 % de índice de respuesta). Un total de 181 encuestados (86,2 %) vieron los videos y la mayoría los percibieron útiles en: Aprender sobre la anatomía de los miembros (68 %), preparación para el laboratorio (56,9 %), revisión posterior al laboratorio (65,7 %) y preparación para la prueba práctica (66,3 %). Cuando se les pidió retroalimentación, los estudiantes solicitaron un aumento en la cantidad de videos para incluir estructuras distintas de los músculos. Los estudiantes informaron que perciben a los videos como un recurso útil en el curso de anatomía musculoesquelética. La brevedad de los videos los hizo de fácil acceso y posibles de utilizar repetidamente. Estudios más amplios a futuro, basados en la utilización de los videos existentes, como también aquellos producidos recientemente, podrían arrojar más luz sobre su total potencial educativo.

Bilateral Neovascular Age-Related Macular Degeneration: Comparisons between First and Second Eyes.

PURPOSE: To compare 12-month outcomes and clinical presentations between first and second eyes of patients who developed neovascular age-related macular degeneration (nAMD) in both eyes and received ranibizumab intravitreal therapy (IVT). METHODS: This is a retrospective case series of 45 patients undergoing IVT for unilateral nAMD who subsequently developed second-eye nAMD. At each visit, both eyes underwent visual acuity (VA) measurement and optical coherence tomography (OCT). RESULTS: In second eyes, 53% were asymptomatic at baseline, with OCT retinal fluid as the only sign of nAMD among 33% of patients. In eyes with baseline VA >6/9, 82% of second treated eyes maintained this vision versus 12% of first eyes (p = 0.05). At 12 months, 70% of second eyes were fluid free versus 41% of first eyes (p = 0.02). CONCLUSIONS: A large proportion of patients are asymptomatic at diagnosis of second-eye nAMD. Early intervention following earlier detection of nAMD in the second eye may lead to improved clinical outcomes.

Influence of Retinal Pathology on the Reliability of Macular Thickness Measurement: A Comparison Between Optical Coherence Tomography Devices.

BACKGROUND AND OBJECTIVE: To evaluate the repeatability, reliability, and comparability of macular thickness measurements between three optical coherence tomography (OCT) machines in healthy eyes, eyes with diabetic macular edema (DME), and eyes with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: Twenty-three eyes with DME, 26 eyes with nAMD, and 24 healthy eyes as controls were evaluated. Scans were performed using the swept-source Triton (Topcon, Tokyo, Japan), the spectral-domain Cirrus (Carl Zeiss Meditec, Dublin, CA), and the Spectralis (Heidelberg Engineering, Heidelberg, Germany) machines. Scans were evaluated for central macular thickness (CMT), presence of segmentation and fixation imaging artifacts (IA), re-scan reliability, and agreement between machines and groups. RESULTS: Mean CMT was significantly different between all OCT machines in all groups (P < .01 for all comparisons). Manually correcting IA did not alter these results. There was good scan repeatability among healthy and DME eyes for each machine, but poor repeatability among the nAMD group with the Spectralis (P = .038). IA were significantly increased in the presence of pathology. CONCLUSIONS: There is poor agreement of CMT measurement between OCT machines in healthy eyes and those with DME and nAMD. DME and nAMD have a significant effect on the rate of IA in scans. Care is required when interpreting measurements from different OCT devices in clinical practice and research settings. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:319-325.].

Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration.

PURPOSE: To assess changes in vision-related quality of life (VR-QoL) among patients with treatment-resistant neovascular age-related macular degeneration (nAMD) following intravitreal aflibercept treatment over 48 weeks. METHODS: We conducted a prospective study in which 49 patients with nAMD resistant to anti-vascular endothelial growth factor therapy were switched to intravitreal aflibercept. Patients were treated with three loading doses every 4 weeks followed by injections every 8 weeks, for a total of 48 weeks. Ophthalmic examinations performed at each visit included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurement. The National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess VR-QoL at baseline and weeks 24 and 48. Changes in NEI VFQ-25 composite and subscale scores were analyzed using paired t tests. The relationship between the change in VR-QoL and changes in BCVA and CMT, and the impact of the better-seeing eye (BSE, defined as the eye reading the greater number of letters at baseline) vs. the worse-seeing eye (WSE, the fellow eye to the BSE) were assessed. RESULTS: Mean NEI VFQ-25 composite scores improved significantly at weeks 24 and 48 compared to baseline (4.5 ± 9.2 and 4.4 ± 11.8, respectively, all p < 0.01). Among subscales, general vision and near and distance activities showed significant improvements at weeks 24 and 48 (all p < 0.05). Improvement in the NEI VFQ-25 composite score was significantly associated with increased BCVA at week 48 (ß coefficient = 0.43, p = 0.029), but not with change in CMT (ß coefficient = -0.007, p = 0.631). There was no association between VR-QoL changes and BSE or WSE. CONCLUSION: Despite previous anti-VEGF treatment in this cohort, overall VR-QoL improved following aflibercept therapy over 48 weeks. This improvement was related to improved vision in treatment eyes regardless of whether they were the BSE or WSE.

Safety and Efficacy of Intravitreal Preservative-Free Triamcinolone Acetonide (Triesence) for Macular Edema.

PURPOSE: To evaluate the efficacy and safety of preservative-free triamcinolone acetonide (Triesence) for the treatment of macular edema. METHODS: A retrospective study was conducted on patients who attended a tertiary retinal clinic from June 2009 to July 2012 with macular edema due to various causes. Patients who received at least 1 intravitreal Triesence injection and completed 6 months of follow-up were recruited. Data, including best-corrected Snellen visual acuity, central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs), were collected at baseline, week 1, month 1, month 3, and month 6 after initiation of treatment. Snellen visual acuity was converted to visual acuity score (VAS) for statistical analysis using paired t-tests and linear regression. RESULTS: One hundred two eyes from 102 patients were included in the study. Mean VAS was significantly improved at all follow-up time points compared to baseline (P≤0.002), with highest mean gain at month 1 (6.1±8.9 letters). Mean CMT decreased significantly at all follow-up points compared to baseline (P≤0.0005), with the greatest reduction at week 1 (146.6±109.4 µm). A total of 22 AEs were observed, and IOP elevation was the most common AE related to Triesence treatment (17/22, 77.3%). No sterile or infectious endophthalmitis was observed. CONCLUSION: Intravitreal Triesence improves visual acuity and reduces macular thickness in eyes with macular edema from various causes. Treatment-associated IOP elevation was manageable with antiglaucoma medications. There were no serious vision-threatening complications associated with intravitreal Triesence therapy during the study period.

Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes.

BACKGROUND: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are the established standard of care for neovascular age-related macular degeneration (nAMD). However, data on long-term outcomes of this therapy are limited. The purpose of this study was to assess the visual and anatomical outcomes and safety profile of intravitreal ranibizumab in treating nAMD over a period of five years. METHODS: 208 patients (208 eyes) were included in this retrospective case series study. Intervention was an "as-needed" treatment model. Visual acuity (VA), central macular thickness (CMT), ophthalmic examination, and adverse events (AEs) were assessed in each visit. Snellen VA was converted to Early Treatment Diabetic Retinopathy Study letters for analysis. RESULTS: The average VA improved by 1.9 letters after one year (p = 0.017), and decreased by 2.4 letters over five years of treatment (p = 0.043). At the end of year five, 11.1 % of patients (23/208) had improved VA by more than 15 letters and 68.8 % (143/208) had VA improvement or loss less than or equal to 15 letters, while 20.2 % of patients (42/208) had a loss of more than 15 letters. Patients with VA of less than 35 letters at baseline showed significant VA improvement after five years of treatment. There was a positive relationship between injection numbers and VA improvement over the five-year period, after adjusting for age and baseline VA (p < 0.0005). Mean CMT decreased by 28.3 µm (p < 0.0005) over five years. Ocular AEs, serious adverse events (SAEs), and systemic SAEs occurred in 4.6 %, 0.48 %, and 2 % of patients, respectively, during the follow-up period. CONCLUSIONS: The use of intravitreal ranibizumab in an as-needed treatment regimen over a five-year period was effective in maintaining vision in patients with nAMD and in reducing macular thickness, with a relatively low rate of adverse and serious adverse events.

Do Asian women do as well as their Caucasian counterparts in IVF treatment: Cohort study.

AIM: To evaluate if there is a difference in pregnancy rate between Asian and Caucasian women when they undergo in vitro fertilization (IVF). METHODS: This was a retrospective cohort study set in a private reproductive medicine clinic. The study consisted of a total of 2594 patients (Asian, n = 522; Caucasian, n = 2072) undergoing IVF managed by a single doctor over a 10 year period. The main outcome measures were clinical pregnancy rate and live birth rate. Logistic regression was used to control for confounding factors. RESULTS: Asian women achieved a significantly lower clinical pregnancy and live birth rate than their Caucasian counterparts, despite replacement of more embryos. This difference was not significant after controlling for age and duration of infertility. Despite higher doses of gonadotrophin, they achieved fewer oocytes and had resultant fewer embryos for transfer or cryopreservation. CONCLUSIONS: In a study designed to reduce the effect of confounding factors by looking at a large number of patients from a single IVF unit under the care of a single doctor, there does not appear to be a difference in IVF pregnancy rate as a result of race. Asian women tend to present for IVF treatment at a later age after having tried for a longer period of time and this contributes significantly to their lower pregnancy rate.

Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women.

AIM: To study the outcome of biopsy-diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC). MATERIAL AND METHODS: Patients (n = 131) were analyzed for histological results on LEEP/CKC specimen. Demographic and risk factors, referral cytology, high risk human papilloma virus (HR HPV) test and follow-up colposcopic clinic visits were studied. RESULTS: Excisional specimens from LEEP/CKC demonstrated no CIN in 20 (15%), CIN 1 in 17 (13%), CIN 2 in 57 (44%) and CIN 3 in 37 (28%). No invasive cancers were identified. The referral Pap smear was high grade or possible high grade in 52 (40%), low grade in 59 (45%) and inconclusive in 20 (15%). Fourteen patients (11%) had positive excisional margins, eight of the 14 were tested for HR HPV infection before LEEP, and all were positive. Post-treatment HPV testing was performed at the 12-month visit in 6 of the 14 patients who had positive excision margins, and all 6 tested were negative. Two women (1.5%) with clear margins had recurrence of CIN 2, both tested positive for HR HPV after treatment. CONCLUSION: Our data showed that a significant number of women (28%) with biopsy-diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2.

Site-specific prolapse surgery. I. Reliability and durability of native tissue paravaginal repair.

INTRODUCTION AND HYPOTHESIS: This study aims to compare native tissue abdominal and vaginal paravaginal repair, and to investigate whether surgical outcome was independent of operative route. METHODS: Retrospective comparison of 111 displacement cysto-urethrocoeles, repaired between 1997 and 2007. Treatment was by surgeon assignment, 52 women having abdominal (APVR) and 59 vaginal paravaginal repairs. Main outcome measures were same-site prolapse recurrence, time to failure and surgical complications. Initial reliability was evaluated by chi-square test, 10-year durability by Kaplan-Meier survival analysis and Cox proportional hazards model. RESULTS: When examined in the Cox proportional hazards model, anatomic results of APVR were more durable than a mechanically analogous transvaginal operation done [95% CI = 1.029-2.708 (p value = 0.038)]. Kaplan-Meier curves plateaued within 38 months. Symptom resolution was broadly equivalent. Surgical complication rate was 3.6%. CONCLUSIONS: Site-specific re-suture of torn native tissue has genuine curative potential. Most of the long-term success was attributable to site-specific repair, rather than non-specific scar formation.

Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft.

INTRODUCTION AND HYPOTHESIS: This study aims to answer the question, "Does tissue augmentation improve the mechanical repair of displacement cystourethrocoele?" METHODS: A retrospective cohort study comparing 108 bridging graft vaginal paravaginal repairs (89 tissue-inductive xenografts and 19 polypropylene mesh) to 59 native tissue historical controls was conducted. Main outcome measures were same-site prolapse recurrence and time to failure. Initial reliability was evaluated by chi-squared test, 10-year durability by Kaplan-Meier survival analysis and risk factors by Cox regression. RESULTS: Late recurrence was 17.7% lower with augmentation (logrank test χ (2) = 8.4, p value = 0.0038 < 0.05, adjusted regression analysis χ (2) = 2.94; p value = 0.0866 <0.10), implicating collagen degeneration in repair failure. CONCLUSIONS: Rebuilding the pubocervical septum, from arcus to arcus and pubic ramus to pericervical ring, satisfies the mechanical but not the metabolic hernia principles. Bridging grafts simplify technical repair (reducing prolapse persistence from 10.2% to 4.6%), and also rejuvenate adjacent connective tissue (reducing late recurrence from 22.6% to 4.9%).

One-year follow-up study on golf injuries in Australian amateur golfers.

BACKGROUND: Considering its popularity, little epidemiologic literature exists on golf injuries. HYPOTHESIS: The low back is the most common injury location for golf-related injury. Most golf injuries occur as a result of the golf swing, and occur mostly at impact. The variables age, handicap, practice habits, and warm-up habits are associated with injury. METHODS: A prospective survey over 1 year was used to study golf injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers' injuries sustained during the year, location of injury, onset, mechanism of injury, and whether injury occurred during the golf swing or at another time. Additional information was sought on the type of treatment received after injury. Logistic regression was used to examine the epidemiologic patterns of golf-related injury and any possible risk factors for the injury. RESULTS: The overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person. Recurrent injuries were most common, while injuries were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18.3%), closely followed by the elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%). A total of 46.2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23.7%), followed by the follow-through (21.5%). Multivariate analysis revealed that the amount of game play (odds ratio [OR] = 3.73, 95% confidence interval [CI] 1.29-10.75) and the last time clubs were changed (OR = 0.32, 95% CI 0.12-0.86) were significantly associated with the risk of golf injury (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significantly associated with golf injury. CONCLUSIONS: Nearly 16% of Australian amateur golfers may expect to sustain a golf-related injury per year. The injuries in golf are most likely sustained in the lower back region as a result of the golf swing. Based on statistical analysis, only game play and a changing of clubs seem to be significantly associated with risk of injury after adjusting for other risk factors (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significant.

Golf-related lower back injuries: an epidemiological survey.

OBJECTIVE: This study describes the playing characteristics of golfers who had an injury to their lower back in the course of play or practice in the previous year (12 months). METHODS: A retrospective survey was mailed to members of randomly selected golf clubs across Australia. Statistical methods used included 2-sample t test to compare means of 2 independent populations and the chi(2) test to examine the association between categorical variables/factors in the study. RESULTS: Of 1634 Australian amateur golfers surveyed, 17.6% of golfers sustained at least 1 injury in the previous year. The lower back accounted for 25% of all golf-related injuries in the previous year, making the lower back the most common site of injury. The golfer with a golf-related lower back injury was likely to have a previous history of lower back injury, while the injury had a progressive onset compared with an acute single onset. The follow-through phase of the golf swing was reported to be associated with the greatest likelihood of injury compared with other phases of the swing. Most of the injured golfers received treatment of their injury with a general practitioner (69%), a physiotherapist (49%), or a chiropractor (40%). CONCLUSION: Practitioners treating golfers with a history of lower back injury should evaluate the golf swing follow-through to identify potential causes of aggravation to the lower back. Targeted measures such as spinal manipulative therapy, soft tissue and back exercise, and conditioning programs to assist the strength and mobility of the golfer could then be implemented.

Golf injuries: a review of the literature.

Golf is one of a few activities that people of all ages and skill level can play. Injury as with all sports can occur. The low back is the most common injury sustained whilst playing golf, and the dynamic action of the golf swing is a major contributing factor to injury. The golf swing is a complex movement that utilises the whole body in a coordinated fashion and when repeated frequently can result in injury. Injury can be overuse or traumatic in nature. Overuse injuries predominate in the professional golfer, and amateur golfer injury tends to occur secondary to an incorrect golf swing. Upper limb injuries are also common due to their role in linking the fast moving golf club with the power-generating torso. Fortunately, injury from a club or ball strike is rare. More common are the overuse injuries associated with the back, neck and shoulder. Most golf injury data have been collected retrospectively and further epidemiological study of a prospective nature is required to determine injury incidence and factor relating to the onset of injury.