bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of patellar entesophyte in jumper's knee. ultrasound findings in 18 athletes' knees
Authors: Silván D Martínez , Pazos F Baró , Valero A Roldán , Justo X Díaz , Jaén T Fernández
Published: January 2011

Introduction

Patellar tendinopathy (jumper's knee) is a common injury in those sports causing high-torque forces on the patella. Several investigations have tried to elucidate its aetiology, being structural changes in the tendon insertion at the inferior patellar pole the most studied finding. Although the overload at the pole seems to be the cause of the formation of the entesophyte, its role in jumper's knee remains unclear.

Methods

Study design retrospective cohort study with two groups:

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Jumper's knee group (JKG): 12 elite athletes (18 pathologic knees, mean age 29.6±7.09) from different sport specialities, with a clinical diagnosis of patellar tendinopathy from 2007 to 2010.

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Control group (CG): 18 elite athletes (mean age 28.1±5.4) without any previous clinical history of patellar tendon injury.

Anthropometrical measurements, evolution time of symptoms, and grade of tendinopathy (Blazina scale 1–4) were determined, and by means of color Doppler ultrasound examination (Voluson 730 General Electric SP6-12. Multi-frequency linear transducer) structural changes and neovascularisation (Hoksrud criteria) were classified, and tendon thickness (6 mm from the apex) and entesophyte length (if present) were measured.

Results

The average evolution time of symptoms was 22.9 months, and the average Blazina scale grade for JKG was 2.7±1. No statistically significative data were found between anthropometry and symptoms. Ultrasound examination revealed that the entesophyte was present in 16 of 18 pathological tendons (JKG=89%, CG=27%), with a medium length of 6.1±3.6 mm (CG=2.1±0.4mm). Neovascularisation was present in 13 of 18 pathological tendons (JKG=72%, CG=5%), and the average tendon thickness was 69.8% higher in JKG than in CG (JK=8.68 mm/CG=5.11 mm). A direct relationship among entesophyte length, tendon thickness and evolution time of symptoms was found.

Conclusions

Presence and size of a distal enthesophyte in the inferior patellar pole influence the perpetuation of symptoms, and determine tendon degeneration and chronicity.
Platelet-rich plasma (prp) and tendon healing: animal model
Authors: Kaux J F , Drion P , Renouf J , Pascon F , Libertiaux V , Colige A , Le Goff C , Lambert C , Nusgens B , Gothot A , Cescotto S , Defraigne J O , Rickert M , Crielaard J M
Published: January 2011

Introduction

The tendon is a tissue which does not heal easily. Recently, several studies have demonstrated the positive effects of platelets on the healing process of tendons. A local injection of platelet-rich plasma (PRP), which releases in situ many growth factors, has the potentiality to enhance the tendon healing process. The aim of our experiment was to ascertain by an original mechanical measure whether the use of PRP was of interest for accelerating the healing process of rats' Achilles tendons after surgical induced lesion.

Methods

A 5 mm defect was surgically induced in 90 rats' Achilles tendon. Rats were divided into two groups of 45: (A) control (no treatment) and (B) PRP treatment. Rats of group B received a PRP injection in situ after the surgery. Afterwards, rats of both groups were placed in their cages without immobilisation. After 5, 15 and 30 days, 10 traumatised Achilles tendons of each group were dissected and removed. Immediately after sampling, tendons were submitted to a biomechanical tensile test up to rupture, using a ‘Cryo-jaw’. After that, transcriptomic analyses were made on the tendon samples, to study the expression of type III collagen, matrix metalloproteases and tenomodulin. A hydroxyproline dosage was done to quantify the collagen in the tendon during its healing process. Tendons of the 15 remaining rats of each group were subjected to a histological study, respectively at day 5, 15 and 30 (five rats for each time).

Results

We demonstrated that the force necessary to induce tendon rupture during biomechanical tensile test study was greater for tendons which had been submitted to an injection of PRP compared to the control group: +19% (day 5), +30% (day 15) and +43% (day 30). Histological study showed that PRP could enhance cells proliferation, angiogenesis and collagen organisation. Our biochemical analyses did not explain beneficial effects of PRP. Indeed, there was no significant difference neither between the expression of different studied genes, nor in the quantity of hydroxyproline between both groups.

Conclusion

This experimentation has shown that a PRP injection could accelerate the tendons healing process and improve its quality.
Pitch side combined assessment for suspected ankle fractures
Authors: Pechlivanidis H , Malliaropoulos N , Christodoulou D
Published: January 2011

Objective

To assess the sensitivity of two musculoskeletal tests as primary examination for on site use.

Methods

I searched through electronic search engines for articles ranging from 2000 to 2010. I used the key words: ankle injuries, ankle examination, ankle assessment and tuning fork.

Data synthesis

Ankle injuries are a common injury in sport accounting for 15–45% of all sport injuries. 85% of all ankle injuries concern the lateral ankle complex. However differential diagnosis suggests the examination of fractures such as at the malleolus, fifth metatarsal, navicular, anterior calcaneus process and at the midtarsal bones. During sport events in the misfortune incidence of an ankle injury physicians are required to assess their athletes. However according to each games rules and situation they are required to assess in shortest time possible.

Ottawa ankle rules (OAR) have been suggested to have a high sensitivity to detect to assess fractures (Northrup et al 2005; Papacostas et al 2001). Papacostaset al(2001) examined 122 patients and found 100% sensitivity for maleolar and midfoot fractures when applied the OAR. Leddyet al(2002) found 100% sensitivity in 217 patients applying the OAR-Buffalo modification. Moore (2009) found high sensitivity (n=10) using a tuning fork for the detection of transverse fractures. Further is suggested that the use of a tuning fork is an fast and reliable method to assess possible fractures (Moore 2009).

Conclusion

We believe that the combination of those two tools can provide a clear and fast initial evaluation during an event. Nevertheless in a clinical or on site setting can further increase reliability for assessing fractures where x-ray is not available. However, further investigation is required regarding the reliability of the tuning fork in assessing fractures, reliability of the examiner and time required to complete the progressive examination.
Low-level laser therapy (LLLT) for discogenic back pain
Authors: Malliaropoulos N , Akritidou A , Tsifountoudis I , Tsitas K
Published: January 2011

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on low back pain documented by history, clinical examination, MRI findings of the Lumbar Spine and patients' pain scores. 39 individuals with diagnosis of low back pain were enrolled in randomised, double-blind, placebo-controlled trial, but 32 participants completed the therapeutic protocol. After enrolment, symptomatic individuals were randomly assigned to receive LLLT, or identical placebo, for 6 weeks. MRI was performed at baseline of therapy. The subjective low back pain was recorded at baseline and after treatment on a visual analogue scale. After LLLT, low back pain in both groups showed significant change over the experimental period and there was a significant difference (before treatment and after treatment) in discogenic back pain between the two groups. Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. Additionally when the difference in pain scores was compared between the two groups the change was statistically significant. In summary, while MRI findings are able to depict the morphologic changes related to discogenic back pain, 905 nm gallium-arsenide infrared laser may contribute to healing and pain reduction in discogenic low back pain.
Re-injury following acute posterior thigh injuries in elite track and field athletes
Authors: Isinkaye T , Malliaropoulos N , Tsitas K , Maffulli N
Published: January 2011

Introduction

Hamstring muscle strains can lead to an increased risk of reinjury. We recently proposed a clinical classification system for acute hamstring strains. We studied the effect of the grade of the initial injury on the subsequent risk of reinjury. We hypothesised that there would be no difference in reinjury rate between acute low grade (grade I and II) and high grade (III and IV) hamstring muscle strains.

Methods

Between 1994 and 2007, we managed 165 elite Greek track and field athletes with acute, first-time unilateral hamstring muscle strains. Using a validated classification system, strains were classified into four grades (I, II, III and IV) based on objective clinical criteria (knee active range of motion deficit at 48 h). The same rehabilitation protocol was prescribed to all athletes and the rate of reinjury was recorded during the following 24 months.

Results

At follow-up, 23 of the 165 athletes (13.9%) had experienced a second hamstring muscle strain. Of the 75 athletes presenting with a grade I injury, 7 (9.3%) had experienced a recurrence after 24 months. Of the 58 athletes presenting a grade II injury, 14 (24.1%) experienced a recurrence. Of the 26 athletes presenting a grade III injury, 2 (7.7%) experienced a recurrence and of the 6 athletes presenting a grade IV injury, none had experienced a recurrence after 24 months.

Conclusions

According to our classification, athletes with acute grade II hamstring muscle strains experience a higher risk of reinjury than athletes with grade I or grade III strains. Low grade hamstring muscle sprains lead to a higher risk of reinjury than high grade hamstring muscle sprains. Objective clinical findings can accurately predict the risk of reinjury following acute hamstring muscle strains.
Treatment of talar osteochondral lesions using local osteochondral talar autograft mid term results
Authors: Evangelou Evangelos , Badekas Thanos
Published: January 2011

Background

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of treatment methods exist for OLT. The use of local Osteochondral talar autograft is an established treatment method for such articular cartilage defects. We present a series of patients treated this way for osteochondral defects of the ankle, and assess the functional and clinical long-term results.

Materials and methods

From March 2005 to December 2008, 11 patients underwent implantation of local osteochondral talar autograft for OLT, 6 male and 5 female. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. Graft sizes ranged from 4 to 8 mm in diameter. Age ranged from 19 to 53 (mean 38) years. Sports related injury concerned eight patients and the duration of symptoms was mean 65 months (range 6–98). Mean follow-up was 41 months (range 16–61). Preoperative and postoperative results evaluated used the American Orthopaedic Foot & Ankle Society (AOFAS) score. Special diagnostics studies performed preoperative, MRI (11 patients), computed axial tomography (11 patients), bone scan 2 patients and weight-bearing radiographs to all of them to evaluate the injury.

Results

All osteotomies healed. The AOFAS average score improved from mean 65 pre- to 89 postop. The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. Concerned satisfaction all the patients would have the procedure again. The most common post op complaint was a mold ache at anteromedial joint line of the ankle. There were no complications in the study group. Most returned to pre injury level of activity. Two patients had a second look arthroscopy one 6 and one 12 months post because of impingement of lateral malleolus the first and debridement of anterior tibial margin the second. Both of them had incorporation of the graft into the surrounding talar dome cartilage.

Conclusion

We believe treatment of talar osteochondral lesions using local osteochondral talar autograft is a reliable treatment method. The long-term results confirm that it is a well-accepted procedure from the patients with no high risk of complications compared to other procedures.
Is soy milk a better recovery aid compared to semi-skimmed milk after exercise? does it increase time to exhaustion in trained cyclists?
Authors: Ravalia Shimal
Published: January 2011

Introduction

Milk has been proven to be a popular recovery drink for trained cyclists to achieve high profile results because milk contains carbohydrates and protein. On the other hand, research has now shown that Soy milk can be just as effective as semi skimmed milk as it contains the same high quality protein.

Method

For the first visit, eight male trained cyclists took part in a maximum oxygen consumption test (VO2max) to determine each participant's VO2 max and maximum power output (Pmax).

The second visit consisted of the glycogen depletion trial where each participant had to cycle at 90% of their Pmax for 2 min and then cycle for 2 min at 50% of their Pmax. This was in a form of intervals and continued until participants could no longer maintain their pedal rate. The percentage was then decreased to 80%, 70% and 60%.

This was followed by a 4 h recovery period. Participants were given 355 ml of soy milk or semi-skimmed milk in a double blind, randomised design at the start and then 2 h into the recovery process. Both drinks were masked with 10 g of cocoa powder.

The Endurance trial followed which required participants to cycle at 70% of their Pmax until exhaustion. Heart rate, body hydration, blood lactate, food diaries and gastrointestinal distress questionnaire were variables that were also measured throughout.

Results

Time to exhaustion at the end of the endurance trial showed six out of eight participants cycled for longer with semi-skimmed milk (11.9±3.6 min). Only two participants cycled longer with soy milk (9.9±3.2 min). There were no significant differences in the results or any of the variables measured.

Conclusion

The present study did not reveal significant results when testing for the relevance of the ingestion of soy milk over semi-skimmed milk.
A reliability assessment examining the inter- and intraobserver reliability of the current england and wales cricket board musculoskeletal profiling protocol
Authors: Dacombe Peter , Ranson Craig , McCaig Steve , Young Mark
Published: January 2011

Background

The England and Wales Cricket Board (ECB) musculoskeletal profiling was first introduced in 2005 and has been developed over the past four seasons with the aim of identifying risk factors for injury in elite level cricketers aiding both injury prevention and rehabilitation. The ECB Physiotherapy Team carries it out at six monthly intervals. The ability of such a tool to accurately predict injury risk, and to provide useful information for rehabilitation is entirely dependent on the ability to produce valid and reliable results.

Study aim

To examine the inter- and intraobserver reliability of the current system in the hands of two experienced sports physiotherapists examining elite level cricketers.

Methods

Using the prescribed testing protocol eight members of the England under 19 cricket squad were examined on two occasions by two sports physiotherapists who have worked in elite level cricket. Statistical analysis was carried out to determine the inter- and intraobserver reliability of the tests.

Results

Of seven range of motion tests included in the study four showed ‘almost perfect’ reliability, an intraclass correlation coefficient of greater than 0.8, this level is reported to be an acceptable for screening in an elite sport setting. Only two of the tests examined demonstrated inter-rater reliability of greater than 0.8.

Conclusion

The ECB musculoskeletal profiling system is crucial to early identification and modification of injury risk factors. It is well-designed and based on current sports injury literature, but can not be efficacious in the absence of reliable testing. Only two of the current tests have sufficient inter-observer reliability for use in screening elite sportsman, four demonstrating acceptable intraobserver reliability. One of the tests (modified Thomas test) demonstrated such poor reliability to question it's inclusion, this study highlights the need to investigate ways to improve the reliability of other tests in the profiling system.
Training risk factors associated with wrestling injury
Authors: Stanev S , Dimitrova E
Published: January 2011

Introduction

Wrestling is strength sport that requires a large amount of muscle stamina superior flexibility, control and intensive training. The incidence of traumatic and overuse injury is high.1 2 The purpose of this study is to determine injury risk factors associated with wrestling training.

Methods

120 (male and female) wrestling students aged 18–26.5 years were recruited from National Sports Academy. We retrieved through injury survey, information regarding chronic injuries, most recent wrestling related injuries as well as treatments, training history and awareness of injury prevention strategies. Risk factors were analysed by Pearson's correlation, ANOVA and t tests.

Results

The results indicate that 45.8% of wrestlers had sustained an injury within the past 6 months. The majority of wrestlers (52.5%) reported being affected by chronic injuries at the time of the survey. Age of onset for wrestling-related and chronic injuries averaged 15 and 17 years. The knee and ankle3 were the most common sites of injury (35%). Arms, shoulders, and hands injuries account for 20% of all injuries. The majority of participants (82%) who required treatment for their most recent wrestling-related injuries consulted a physiotherapist.4 Two of the significant risk factors for injuries were training over 8 h per week (p<0.001) and the training methodology.

Conclusions

An individual training threshold may exist for wrestlers, which if exceeded, increases the risk of injuries. In freestyle wrestling these injuries most commonly affect the knee and ankle. A well-planned weekly training load may reduce injuries. As participation in sport activity does not increase injury risk, cross-training may improve these athletes’ fitness during competition period. Physiotherapists and coaches have a role in developing such a training program.
Accelerated rehabilitation following bilateral consecutive matrix autologous chondrocyte implantation in the knees of an elite skier
Authors: Epaminontidis K , Papacostas E , Koutloumpasis A , Ziogas G , Terzidis J
Published: January 2011

Purpose

To present our experience with an interesting case of bilateral consecutive matrix autologous chondrocyte implantation (MACI) in the knees of an Olympic level skier. The rehabilitation protocol applied had a few but significant differences compared to other protocols, regarding the rate and methods of increasing joint loading during the early phases of rehabilitation.

Methods and materials

A 29-year-old, alpine skier with bilateral chondral lesions of the trochleas and the left lateral femoral condyle. Preoperative International Knee Documentation Committee subjective score was 58(L) and 62 (R). In October 2007, he underwent bilateral knee arthroscopic evaluation and cartilage biopsy. In November 2007 the first MACI was conducted in his left knee, and the second MACI in the right knee in March 2008. A second look arthroscopy took place in the left knee. The rehabilitation protocol followed the guidelines outlined by Hamblyet al(2006) with a few modifications:

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Non-weight bearing

(left knee): 4 weeks (right knee): 1 week

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Full weight bearing

(left knee): 6 weeks (right knee): 4 weeks

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Closed kinetic chain exercise (rowing-free handed)

(left knee): 6 weeks (right knee): 6 weeks

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Intermmitent compression of repair site with use of dynamometer Controlled isometric contractions in angles that engaged the repaired sites. The applied load was controlled via optical biofeedback from dynamometer.

(left knee): 8 weeks (right knee): 10 weeks

Results

The athlete was able to returned to acceptable performance levels on the exercise physiology lab at 8 months. He was able to participate in high level races by 12 months. His 12 month IKDC score reached 94 (L) and 88 (R).

Conclusions

Accelerated rehabilitation with the inclusion of controlled intermmitent compression of the repair sites early in the rehabilitation process is safe and may promote tissue regeneration at a faster rate than previously thought.
Back and leg pain and directional preference exercises
Authors: May Stephen
Published: January 2011

Lecture 13

Directional preference exercises are determined during the physical examination of patients with back pain and referred pain from the spine with the use of repeated movements by the patient. There maybe clues to this found during the history taking, such as the patient indicates they are better when walking and worse when sitting – this could be a clue to a favourable response to extension activity and negative response to flexion activity. This would be explored in the physical examination by testing out the response to repeated extension exercises. If the patient reported centralisation of pain, which is the abolition of distal symptoms, or a decrease in symptom intensity or abolition of symptoms in response to the repeated movement they would be deemed to have a directional preference for extension exercises. These would prescribed for the patient self-management exercises. There is considerable evidence supporting the favourable long-term prognosis associated with centralisation. Furthermore there is evidence to support the use of directional preference exercises in favour of non-specific exercises. This presentation will examine the evidence for directional preference in general, but also specifically as it relates to patients who present with back pain and referred symptoms. The evidence provided will demonstrate the value of directional preference exercises for this group of patients in the athletic and non-athletic populations.
The use of prolotherapy injections for elite athletes
Authors: Petrides Simon
Published: January 2011

Lecture 14

The clinic embraces all aspects of sports and exercise medicine from ‘exercise on prescription’ and ‘functional rehab programmes’ to specialist image guided spinal injections.

Simon has a special interest in prolotherapy injections as an adjunct to intense rehab programmes for unremitting low back pain. This has culminated in successful treatment of many elite athletes and footballers.

Most clinical trials on the treatment have shown significant benefits but no prominent trials have used patients with specific back pain diagnoses using selective block injections to determine which patients are most likely to benefit.

Rowing has a low back pain incidence of 100% and over 20 GB rowers have been successfully treated using this technique.

The lecture will summarise his experience in the use of prolotherapy in these athletes.
Achilles tendon overuse injuries: risk factors and biomechanics
Authors: Alt Wilfried , Reule Claudia , Hochwald Harald
Published: January 2011

Lecture 16

Introduction

Many studies have been published concerning overuse and acute injuries of the lower extremity with respect to individual risk factors.1 Based on the studies by Isman and Inman2 it has been speculated that inclination and deviation of subtalar joint axes (STA) could be used to estimate the risk to chronic or acute injury. In this novel approach a method has been used to determine a set of parameters, describing the axes of rear foot movement with respect to the tibia. The aim of the study was to measure STA of runners with and without chronic symptoms of Achilles tendon (AT).

Methods

The Zebris motion analysis system has been adapted for STA estimations. By postulating a pure rotational movement arround the STA the system could be reduced to only one ultrasound marker which was fixed rigid to the rear foot complex by a special mountig device. The ankle has been moved to maxium dorsiflexion. Then rearfoot has been moved from inversion to eversion six times. A set of six finite axes between the end positions was calculated in real time and then averaged in order to minimise errors from data capturing. A total of 614 axes were calculated from 307 high level runners.

Results and discussion

Data of this study revealed an average inclination of 42° and an average deviation of 11° from 614 ankles. Significant differences have been found between deviation angles from ankles with AT problems (18° ± 23°) compared to those without AT problems (10° ± 23°). Compared to data of Isman and Inman2 (23° ± 11°) it seems that the average deviation of the STA is smaller and therefore more parallel to the longitudinal axis of the foot, which is also in line with the findings of Lewiset al3 (18° ± 10°). It has been speculated that AT problems might be related to asymmetrical loading during running and this is supported by the findings of this study. However, the range of data and SDs are actually higher than published in previous studies. Further investigations are necessary to shed light on anatomical factors and other reasons for AT problems in runners.

Conclusions

This method can be used to estimate a functional joint axis which is closely related to STA orientation. This might be useful, especially to investigate large sample sizes in order to detect individual risk factors to chronic AT overuse in running.
Hamstring injuries
Authors: Malliaropoulos N G
Published: January 2011

Lecture 17

Muscle injuries are among the most common, most misunderstood, and inadequately treated conditions in sports. According to some studies, muscle injuries account for 10–30% of all injuries in sport.1 Hamstring injuries are the commonest muscle injury in all sports.

Hamstrings function is complex. Depending on leg positioning and relationship to the ground it can serve as a hip extensor, knee flexor and external rotator of the hip and knee. Long head receives innervations via a tibia portion of the sciatic nerve, the short head receives innervations from the common personal nerve.

The mechanism of the injury is very important to know. Contraction injuries occurring during running at maximal or near-maximal speed primary involve biceps femoris, long head and they heal faster comparing to stretching injuries occurring in dancing or kicking and primary involving semimembranosus, proximal tendon.2

Various systems have been used to classify the severity of the injury. They classify them in three grades, as mild, moderate, severe, according to imaging findings, time to walk pain-free.3 Our Clinical classification is based on estimating the knee active range of motion deficit between the injured and the healthy side.1 Ultrasound is used to image the muscle lesion.4 Following this clinical classification we are able to decide for the treatment, to design the rehabilitation protocol to predict the time to full rehabilitation and to assess the reinjure rate.

We must always keep in mind to differentiate common signs and symptoms of a hamstring strain injury compared to those referred to the posterior thigh from another source.5

Rehabilitation is one of the key points dealing with hamstring injuries. We as clinicians have to prescribe the right clinical application correlated to each healing process phase operative intervention is reserved only for severe injuries, such as complete rupture of the hamstring muscles, either at the insertion or at the origin (avulsion).

The reinjure rate for hamstring injuries has been found to be 12–31% early return to sport and poor rehabilitation programme met with a high risk of reinjure according to our clinical classification. Objective clinical findings can provide an effective clinical tool to assess the risk of re-injury following acute hamstring muscle strains in elite track and field athletes.6 In terms of prognosis the following factors have been shown to require a greater convalescent period: injury involving a proximal free tendon, proximity of the injury to the ischial tuberosity, increased length and cross-sectional area of injury.

Past history of hamstring injury is the main risk factor for the next injury.3 Being unable to walk at a normal pacepain-free within 24 h of injury was independent predictor of being unable to return to play in less than 4 weeks from the time of injury. Defining the severity of the injury enable us to assess the expected return to play timescale which is important in guiding rehabilitation and in team planning.6
ESWT in the management of patella tendinopathy
Authors: Motto Stephen
Published: January 2011

Lecture 21

Patella tendinopathy is still a potentially career ending injury if not accurately diagnosed and actively managed. Prevalence has been reported to be in the range of 7–40% in the athletic population. There are still concerns regarding the aetiology, although the mechanical strain theory is the most accepted – repeat heavy loading initiating pathological extracellular and cellular dysfunction with eventual collagen disruption and tendon degeneration.

Musculoskeletal extracorporeal shockwave therapy (ESWT) involves the use of low, medium and high energy focused or non-focused (radial) sound waves that have been shown to have a therapeutic value for certain orthopaedic conditions. ESWT in patella tendinopathy ‘seems to be a safe and promising treatment’ was the conclusion reached by Leeuwenet alin a review of the literature which appeared in theBJSMlast year (BJSM2009;43:163–8).

The mechanism of action of shockwaves remains unknown. It has been postulated that shockwaves induce hyperstimulation analgesia by increasing the threshold of pain. It also seems to increase vascularity and leads to increases in cellular signalling. Focused shockwave therapy has been used in my practice with good results in a number of mild to moderately severe cases.
Predictive genomics profiling in athletics and sports performance
Authors: Kambouris Marios
Published: January 2011

Lecture 27

Genes control biological systems such as muscle, cartilage and bone formation, muscle energy production and metabolism (mitochondriogenesis, lactic acid removal), blood and tissue oxygenation (erythropoiesis, angiogenesis, vasodilatation) all essential in Athletics and Sports. DNA sequence variations in these genes confer genetic advantages that can be exploited and genetic ‘barriers’ that could be overcome to achieve optimal athletic performance.

The four ‘P's of Predictive Genomics (Personalization, Prediction, Prevention, Participation) are not only applicable but rather essential in athletics. Predictive genomic profiling for athletics reveals genetic variations that determine suitability for sports requiring either endurance or strength and speed, determine vulnerability to sports-related traumas as well as individualised nutritional requirements. Knowledge of genetic ‘suitability’ in respect to endurance capacity or strength and speed would lead to appropriate sport and athletic activity selection. Knowledge of genetic advantages and barriers would ‘direct’ an individualised training programme and nutritional plan and supplementation to achieving optimal performance, overcome the ‘pain barriers’ that results from intense exercise and pressure under competition with minimum waste of time and energy and avoidance of health risks (hypertension, cardiovascular disease, inflammation and injuries in tendons and bones) related to exercise, training and competition.

Genetic ‘profiling’ for Athletics and Sports performance is an essential tool for proper Athletic activity and Sport selection as well as for the formulation of Individualized and Personalized training and nutritional programmes for optimising health and performance for the athlete.
So what's really new about the ACL
Authors: King John
Published: January 2011

Lecture 3

This talk will be a look at the origins of anterior cruciate ligament (ACL) mythology; a snapping noise, haemarthrosis and loss of function are characteristic of ligamentous injury; 1845!

Testing for ACL laxity in near extension; 1875

Why do we test for laxity in the sagittal plane when the ACL is oblique?

Why there are thousands of papers on PubMed if the problem is solved?

So what is new, what is hidden because we don't read a foreign language and what does the future hold?
Predisposing factors for anterior cruciate ligament injury
Authors: Papoutsidakis Antonis
Published: January 2011

Lecture 5

In sports, especially in football, one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually (70%) occurs through non-contact mechanisms that include; sudden deceleration, landing and pivoting manoeuvres which are repeatedly performed. Studies have shown that the incidence of ACL tear in female athletes is two to eight times higher than in men athletes. The research effort to determine the risk factors for sustaining non-contact ACL injuries is increasing as concerns grow about the larger number of incidents, the greater treatment costs and the serious consequences of those injuries.

Mechanically, ACL injury occurs when an excessive tension force is applied on the ACL. A non-contact ACL injury occurs when a person generates great forces or moments at the knee that apply excessive loading on the ACL.

There are number of studies that show that the anterior shear force at the proximal end of the tibia is a major contributor to ACL loading, while there are valgus, varus and internal rotation moments at the knee. According to these ACL loading mechanisms, a small knee flexion angle, a strong quadriceps muscle contraction or a great posterior ground reaction force can increase ACL loading.

The literature also shows that individuals at high risk have a smaller knee flexion angle during athletic tasks than individuals at low risk. Recent biomechanical studies demonstrated that female recreational athletes exhibited small knee flexion angles in running, jumping and cutting tasks. The results of other studies showed that the peak ACL strain occurred at the impact peak vertical ground reaction force shortly after initial contact between the foot and the ground.

The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal and biomechanical.

Recently, a high level of friction between shoes and the playing surface has been identified as a major risk factor for a non-contact ACL injury in the sport of the team handball. In football, there are studies that show that more non-contact ACL injuries occur when the surface is dry. Higher levels of friction between the shoe and the surface are generally associated with better performance but a higher injury risk. That's why we see an increase of ACL tears in areas with artificial grass in football grounds.

There is a need to continue to define specific, neuromuscular, proprioceptive and motor control factors associated with injury. However, until specific predictive and protective factors are identified, training and prevention programmes should continue to be implemented, assessed and improved. There is a pressing need to improve public and participant awareness of the risk of ACL injury and the possibilities for prevention.
MPFL reconstruction
Authors: Maffulli Nicola
Published: January 2011

Lecture 6

Primary patellofemoral dislocations are common. It results from quadriceps contraction across a flexed, valgus knee with the weightbearing tibia externally rotated compared to the femur. The dislocation usually reduces spontaneously or with muscle relaxing drugs. In most patients, non-operative management produces satisfactory outcome. Conservative management focuses on concentric exercises to strengthen the quadriceps, and especially the vastus medialis, to prevent further instability. If the dislocation recurs after a trial of rehabilitation, operative intervention should be considered, with the aim of restoring the soft tissue anatomy to normal. Ninety-four per cent of patients suffer a tear to the medial patellofemoral ligament (MPFL) following a patellar dislocation. We perform transverse patella double tunnel technique to reconstruct the MPFL using a free autologous gracilis or semitendinous graft. MPFL reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.
Medial tibial stress syndrome
Authors: Batt Mark E , Batt Mark
Published: January 2011

Lecture 9

Medial tibial stress syndrome (MTSS) is an enigmatic condition with confusing terminology, the term often being used interchangeably with shin splints. It is suggested that MTSS and shin splints be used as generic rather than diagnostic terms. On account of variable definitions, the reported incidence rate varies from 4 to 35% in military and athletic populations. Broadly, it represents exertional lower leg pain centred on the posteromedial tibial border and being diffuse/linear (greater than 5 cm) rather than focal. Presentations of acute shin splints should be regarded as bone stress injuries until proven otherwise and not treated as periostitis with anti-inflammatory modalities/drugs. Chronic presentations are more likely in females, those with a running history less than 5 years, increased body mass index, larger calf girth, increased hip rotation, standing foot pronation and a history of orthotics use, MTSS or stress fracture. Muscle hernia, stress fracture and chronic exertional compartment syndrome should be ruled out. The differential diagnosis also includes radiculopathy, nerve entrapment syndromes and the possibility of an accessory muscle should not be overlooked. There are few randomised controlled trials (RCTs) that have studied treatment and prevention and those available suggest that rest is probably as beneficial as any other form of intervention. Prevention may be afforded by either shock absorbing insoles or more formal orthotics. The pathophysiology would seem to be related to diffuse bone stress with resultant periostalgia. Thus rest and the possible use of compressive splints are advised with a graduated return to running activities once risk factors have been addressed.
A LOW-POWER 12-BIT 250 KS/S CYCLIC ADC FOR LONG LINE ARRAY INFRARED SENSORS READOUT CIRCUIT
Authors: ZHAO HONGLIANG , ZHAO YIQIANG , LI PENG , JIANG JUNWEI , ZHANG ZHISHENG
Published: January 2011

A 12-bit cyclic analog to digital converter (ADC) used in long line array infrared sensors readout circuit is presented. The architecture of a low-power amplifier shared with two groups of switched capacitors is used to reduce power consumption. By adding cross-connected switches, the amplifier's offset is effectively canceled out. The improved redundant signed digit (RSD) correction technique is employed to compensate for the error resulting from the comparator's offset in sub-ADC, and the correction technique can tolerate high level of switched capacitor mismatch error, as well. The converter manufactured with Chartered 0.35 μm CMOS process exhibits 0.92 LSB maximum differential nonlinearity (DNL) and 1.5 LSB maximum integral nonlinearity (INL). The ADC has a 69.3 dB signal to noise and distortion ratio (SNDR) at 250 kS/s sample rate and 3 MHz clock frequency. It dissipates 0.8 mW with 3.3 V supply and occupies 0.22 × 0.9 mm2.
A CMOS ANALOG INTEGRATED CIRCUIT FOR PIXEL X-RAY DETECTOR
Authors: FITRIO DAVID , TJOA SUHARDI , MOHAN ANAND , VELJANOVSKI RONNY , BERRY ANDREW , PANJKOVIC GORAN
Published: January 2011

A front-end read-out application specific integrated circuit (ASIC) for a multichannel pixel X-Ray detector system has been fabricated and tested. The chip provides signal amplification for pixelated compound semiconductors such as Cadmium Telluride ( CdTe ) and Cadmium Zinc Telluride ( CZT ) with either 1 mm or 200 μm pitch. Both the detector (compound semiconductor) and ASIC are combined to target future research applicable to spectroscopic imaging in high intensity X-Ray biomedical detector systems. The ASIC was fabricated in a 0.35 μm process by Austria Microsystems and consists of 32 channels, where each channel contains a charge-sensitive amplifier, a pulse shaper and two further stages of amplification providing an overall gain of 1 mV per kilo electron volt (keV) for photons within the energy range of 30–120 keV. The preamplifier and shaper circuits are designed for both positive and negative charge collection (electrons and holes) produced by the CdTe or CZT detectors. The ASIC's shaper has been designed with a time constant of 100 ns to allow operation at photon rate events above 1 Million photons per pixel per second. The design and characterization of the readout chip will be discussed in this paper presenting results from both the simulated and the fabricated chip.
OPTIMAL DYNAMIC BOX-COUNTING ALGORITHM
Authors: ALEVIZOS PANAGIOTIS D. , VRAHATIS MICHAEL N.
Published: January 2011

An optimal box-counting algorithm for estimating the fractal dimension of a nonempty set which changes over time is given. This nonstationary environment is characterized by the insertion of new points into the set and in many cases the deletion of some existing points from the set. In this setting, the issue at hand is to update the box-counting result at appropriate time intervals with low computational cost. The proposed algorithm tackles the dynamic box-counting problem by using computational geometry methods. In particular, we use a sequence of compressed Box Quadtrees to store the data points. This storage permits the fast and efficient application of our box-counting approach to compute what we call the "dynamic fractal dimension". For a nonempty set of points in the d-dimensional space ℝd (for constant d ≥ 1), the time complexity of the proposed algorithm is shown to be O(n log n) while the space complexity is O(n), where n is the number of considered points. In addition, we show that the time complexity of an insertion, or a deletion is O( log n), and that the above time and space complexity is optimal. Experimental results of the proposed approach illustrated on the well-known and widely studied Hénon map are presented.
ORDERED AND CHAOTIC PHENOMENA IN TWO COUPLED FORCED LCR OSCILLATORS SHARING A COMMON NONLINEARITY
Authors: SANTHIAH M. , PHILOMINATH P. , MOHAMED I. RAJA , MURALI K.
Published: January 2011

This paper suggests a simple mechanism of sharing a common nonlinearity among the linear oscillators to exhibit some interesting phenomena. Here, we present fourth-order nonautonomous circuit capable of showing a large variety of dynamical behaviors in three different modes of operation. In particular, a new phenomenon of coexistence of attractors leading to torus behavior when two identical oscillators sharing a common nonlinearity and many spatio-temporal patterns when more oscillators sharing a nonlinearity are presented. The results of numerical simulations, hardware experimental realization and analytical studies are presented.
WRAPPER-BASED FEATURE RANKING TECHNIQUES FOR DETERMINING RELEVANCE OF SOFTWARE ENGINEERING METRICS
Authors: ALTIDOR WILKER , KHOSHGOFTAAR TAGHI M. , GAO KEHAN
Published: January 2011

Classification, an important data mining function that assigns class label to items in a collection, is of practical applications in various domains. In software engineering, for instance, a common classification problem is to determine the quality of a software item. In such a problem, software metrics represent the independent features while the fault proneness represents the class label. With many classification problems, one must often deal with the presence of irrelevant features in the feature space. That, coupled with class imbalance, renders the task of discriminating one class from another rather difficult. In this study, we empirically evaluate our proposed wrapper-based feature ranking where nine performance metrics aided by a particular learner and a methodology are considered. We examine five learners and take three different approaches, each in conjunction with one of three different methodologies: 3-fold Cross-Validation, 3-fold Cross-Validation Risk Impact, and a combination of the two. In this study, we consider two sets of software engineering datasets. To evaluate the classifier performance after feature selection has been applied, we use Area Under Receiver Operating Characteristic curve as the performance evaluator. We investigate the performance of feature selection as we vary the three factors that form the foundation of the wrapper-based feature ranking. We show that the performance is conditioned by not only the choice of methodology but also the learner. We also evaluate the effect of sampling on wrapper-based feature ranking. Finally, we provide guidance as to which software metrics are relevant in software defect prediction problems and how the number of software metrics can be selected when using wrapper-based feature ranking.
Stabilization and detection of nitroxyl by iron and cobalt porphyrins in solution and on surfaces
Authors: Doctorovich Fabio , Bikiel Damian , Pellegrino Juan , Suárez Sebastián A. , Martí Marcelo A.
Published: January 2011

Nitroxyl (HNO/NO-) is a small short-lived molecule that has been suggested to be produced by nitric oxide (NO) synthases under certain conditions. As for NO , biologically relevant targets of HNO are mainly heme-proteins and therefore, it has been difficult to discriminate the physio-pathological role of each molecule conclusively. Therefore, accurate discrimination between them is still an unresolved matter. On the other hand, there is only scarce information about nitroxyl-metalloporphyrin complexes. Hence, there is growing interest in obtaining and characterizing stable heme model nitroxyl complexes. In this review we show how HNO and NO can be discriminated electrochemically by a Co porphyrin attached to a gold surface, and how nitroxyl can be stabilized by coordination to an electron-poor Fe porphyrin. The Co porphyrin with four anchors, cobalt(II)-5,10,15,20-tetrakis[3-(p-acetylthio-propoxy)phenyl]porphyrin [Co(P)] was covalently attached to gold electrodes, and its reactions with NO and HNO donors were studied electrochemically. By fixing the potential to values that oxidize CoIII(P)NO-, HNO can be selectively detected by amperometric techniques. On the other hand, the one-electron chemical reduction of FeII(TFPPBr8)NO (TFPPBr8= 2 ,3,7,8,12,13,17,18-octa-β-bromo-5,10,15,20-[tetrakis-(pentafluorophenyl)]porphyrin) with cobaltocene yields the significantly stable {FeNO}8nitroxyl anion complex, [Co(C5H5)2]+[Fe(TFPPBr8)NO]-, which was isolated and characterized by several spectroscopies and DFT calculations. This species is intermediate between FeIINO-and FeINO , which is contrasted with the predominant FeIINO-character of known non-heme {FeNO}8complexes.