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BACKGROUND: Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. OBJECTIVE: To determine if international travel increases the incidence of illness in rugby union players participating in a 16-week tournament. SETTING: 2010 Super 14 Rugby Union tournament. PARTICIPANTS: 259 elite rugby players from eight teams were followed daily over the 16-week competition period (22 676 player-days). ASSESSMENT: Team physicians completed a logbook detailing the daily squad size and illness in any player (system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause) with 100% compliance. Time periods during the tournament were divided as follows: located and playing in the home country before travelling (baseline), located and playing abroad in countries >5 h time zone difference (travel) and located back in the home country following international travel (return). MAIN OUTCOME MEASUREMENT: Incidence of illness (illness per 1000 player-days) during baseline, travel and return. RESULTS: The overall incidence of illness in the cohort was 20.7 (95% CI 18.5 to 23.1). For all teams, the incidence of illness according to location and travelling was significantly higher in the time period following international travel (32.6; 95% CI 19.6 to 53.5) compared with the baseline (15.4; 95% CI 8.7 to 27.0) or after returning to their home country (10.6; 95% CI 6.1 to 18.2). CONCLUSIONS: There is a higher incidence of illness in athletes following international travel to a foreign country that is >5 h time difference and this returns to baseline on return to the home country. [ABSTRACT FROM AUTHOR]

Background Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. Objective To determine the incidence, type, cause and consequences of illness in Rugby Union players participating in a 16-week tournament. Setting 8 teams participating in the 2010 Super 14 Rugby tournament Participants A cohort of 259 elite rugby players from eight teams was recruited. Assessmen All players were followed daily over the 16-week competition period (22 676 player days). Each day, team physicians completed an illness log with 100% compliance. Information included the daily squad size and illness details including system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause. Main outcome measurement Incidence of illness (illness per 1000 player days). Results The incidence of illness in the cohort was 20.7/1000 player days (95% CI 18.5 to 23.1) with the highest incidence of illness in the respiratory system (6.4: 95% CI 5.5 to 7.3), gastrointestinal system (5.6: 95% CI 4.9 to 6.6) and the skin and subcutaneous tissue (4.6; 95% CI 4.0 to 5.4). Infections accounted for 54.5% of all illness and 26.1% of illness resulted in time loss of >=1 day. In over 50% of illnesses, symptoms were present for >=1 day before being reported to the team physician. Conclusion Infective illness involving the respiratory tract and gastrointestinal tract together with dermatological illness was common in elite rugby players participating in this international tournament. A delay in reporting of symptoms >24 h could have important clinical implications in player medical care. [ABSTRACT FROM AUTHOR]

Sports concussion research and clinical guidelines have evolved rapidly. The most recent concussion consensus statement and guidelines (Zurich, 2008) provided clinicians with the Sports Concussion Assessment Tool version 2 (SCAT2) as a clinical template for the assessment of acute concussion. For the subsequent serial examinations required for the complete assessment of the concussed athlete, SCAT2 may be inadequate. This paper describes the experience and suggestions of South African sports physicians in evolving a more comprehensive clinical evaluation tool and record of patient care, the Sports Concussion Office Assessment Tool. [ABSTRACT FROM AUTHOR]

Assesses the effects of cigarette smoking on the incidence of non-fatal myocardial infarction. Comparison of tar in different types of manufactured cigarettes; Frequency distributions of smoking habits; Potential confounding factors. INSET: Key messages..

AIMS--A detailed assessment of ophthalmic effects of an HMG CoA reductase inhibitor, simvastatin, was performed. METHODS--Six hundred and twenty one individuals considered to be at increased risk of coronary heart disease were randomised, following an 8 week placebo 'run in' period, to receive 40 mg daily simvastatin, 20 mg daily simvastatin, or matching placebo. Patients with a baseline corrected visual acuity better than 6/24 and without a history of cataract were eligible for detailed ophthalmic assessment at 6 months (539 patients assessed) and at 18 months (474 patients assessed). RESULTS--No significant differences between the treatment groups were detected at the 6 month or 18 month visit in the refractive condition of the eye or in the mean intraocular pressure. Nor were there clear differences in the Oxford grading system scores for various measures of the major types of cataract (cortical spokes, posterior subcapsular cataract, nuclear brunescence, white scatter) or for other morphological features visible within the lens (fibre folds or focal dots). Scheimpflug slit image photographs and retroillumination analysis of the percentage of cataract within a defined region of the lens were also performed at each visit, with no clear differences observed between the treatment groups. CONCLUSION--This single centre double blind study found no good evidence of any adverse effects of 18 months of simvastatin treatment on lens opacity formation, using a variety of validated techniques to assess cataract development. Routine clinic follow up of visual symptoms and admission to hospital for ophthalmic procedures over 5 years of treatment was also reassuring, with no excess adverse outcomes observed with simvastatin. [ABSTRACT FROM PUBLISHER]

Presents the results of a randomized trial on the prophylactic daily aspirin among males in Great Britain. Analysis on the efficacy of aspirin in reducing stroke, myocardial infarction and other vascular conditions; Significance of migraine and musculoskeletal pain in the control and treated group; Correlation between the disabling stroke and the established value of antiplatelet treatment.

The interactions of soluble and insoluble immunoglobulin G (IgG) complexes with macromolecular rheumatoid factor (RF) and platelets were examined in an in vitro system permitting observation of platelet activities which may contribute to rheumatoid inflammation. Studies of the aggregation phenomenon by the nephalometric technique and by selective sedimentation of 51Cr-labelled platelets revealed no aggregation by platelets exposed to heat aggregated IgG (HAIgG) complexes or their RF precipitates in a plasma test system. Release of serotonin was demonstrated by the increasing radioactivity of platelet supernates to 45 min by 14C-serotonin labelled platelets exposed to insoluble IgG heat aggregates. Significantly less release was shown with saline, native IgG, and soluble IgG complexes. When RF was added to soluble HAIgG complexes, the resulting precipitate caused significantly higher release than controls. No concomitant release of the lysosomal enzyme beta-glucuronidase was detected. Thus, although soluble complexes do not cause significant release of biologically active amines, conversion of soluble complexes to insoluble immune precipitates by RF is associated with this activity which is independent of platelet aggregation and/or lyosomal enzyme release in our test system. Release of biologically active amines from platelets exposed to insoluble complexes may be important in the initiation and propagation of inflammation in rheumatoid arthritis. [ABSTRACT FROM PUBLISHER]

To assess the feasibility of conducting a re-survey of men who are resident in the United Kingdom 25 years after enrollment in the Whitehall study of London Civil Servants. A random sample of 401 study survivors resident in three health authority areas was selected for this pilot study. They were mailed a request to complete a self administered questionnaire, and then asked to attend their general practice to have their blood pressure, weight, and height measured and a blood sample collected into a supplied vacutainer, and mailed to a central laboratory. Using a 2 x 2 factorial design, the impact of including additional questions on income and of an informant questionnaire on cognitive function was assessed. Accurate addresses were obtained from the health authorities for 96% of the sample. Questionnaires were received from 73% and blood samples from 61% of the sample. Questions on income had no adverse effect on the response rate, but inclusion of the informant questionnaire did. Between 1970 and 1995 there were substantial changes within men in the mean blood pressure and blood total cholesterol recorded, as reflected by correlation coefficients between 1970 and 1995 values of 0.26, and 0.30 for systolic and diastolic blood pressure and 0.38 for total cholesterol. This pilot study demonstrated the feasibility of conducting a re-survey using postal questionnaires and mailed whole blood samples. The magnitude of change in blood pressure and blood total cholesterol concentrations within individuals was greater than anticipated, suggesting that such remeasurements may be required at different intervals in prospective studies to help interpret risks associations properly. These issues will be considered in a re-survey of the remaining survivors of the Whitehall study. [ABSTRACT FROM AUTHOR]

AIMS--To assess the role of Ki67 immunoreactivity in predicting the clinical progress of hydatidiform mole. METHODS--Tissue from 87 hydatidiform moles, 11 normal first trimester placentas, 11 normal term placentas and 17 spontaneous abortions were examined for expression of Ki67 antigen, using the monoclonal antibody MIB1. RESULTS--Ki67 immunoreactivity was significantly higher in the tissue from normal first trimester placentas than in that from normal term placentas and spontaneous abortions. Among the 87 patients with hydatidiform moles studied, 20 developed persistent gestational trophoblastic disease and required subsequent treatment. There was no statistically significant difference in the Ki67 index between the 20 patients who developed persistent disease and those who did not. CONCLUSION--Hydatidiform moles which give rise to persistent trophoblastic disease do not have a higher proliferative rate than those which do not. The Ki67 index is not useful for predicting the prognosis of molar pregnancies. [ABSTRACT FROM PUBLISHER]

AIMS: To compare the expression of c-myc and c-fms proto-oncogenes in the placenta and hydatidiform mole. METHODS: Twelve hydatidiform moles and six induced abortion cases were collected. c-myc and c-fms proto-oncogene expression was analysed by northern blot hybridisation and immunohistochemical staining. RESULTS: The results of northern blot hybridisation analysis showed that c-fms was expressed more strongly in hydatidiform moles compared with normal placenta of similar gestational age. Moreover, c-fms mRNA concentrations increased with more advanced gestational age in moles but not in normal placentas. c-myc expression was very low in hydatidiform moles and normal placentas. Both oncogenes, however, had no direct correlation with the clinical course of the molar pregnancies. CONCLUSION: The difference in c-fms expression between hydatidiform moles and normal placentas suggests that c-fms may have a role in the development of molar pregnancies. [ABSTRACT FROM PUBLISHER]

The findings of recent surveys indicate a need for standardisation in lymphocyte subset analysis by flow cytometry. Major areas of concern are the methods used for labelling subsets and the choice of appropriate monoclonal antibodies. A standard dual colour manual whole blood lysis technique for flow cytometry was compared with the recently available Coulter Q-Prep EPICS technique. Overall, there was no significant difference (Student's t test) between the use of anticoagulated blood treated with heparin or EDTA. When normal subjects were examined there was a decrease in the absolute number of CD3+ and Leu-7+/CD8- cells and an increase in CD19+ and CD20+ cells. When human immunodeficiency virus (HIV) antibody positive subjects were examined there was a significant decrease in the absolute number of CD2+, CD3+, CD4+ and Leu 7+/CD8- cells and an absolute increase in CD19+ and CD20+ cells. CD8+ cells were decreased only with the Cyto-Stat reagents. Occasionally, the Q-Prep did not lyse the red cells efficiently. While the Q-Prep EPICS system has the potential to standardise and automate the labelling procedures used in lymphocyte subset analysis, further refinement, such as the choice of monoclonal antibodies or alternative preparative reagents, may be required to resolve the cause of the discordant findings between the two approaches. [ABSTRACT FROM PUBLISHER]

A technique for the extraction of cells from bone marrow trephine core biopsy specimens using collagenase digestion was assessed in 39 cases (33 diagnostic and six normal). Diagnostically useful numbers of cells were extracted from all marrows. Morphological assessment of cytocentrifuge preparations of these cells gave a correct diagnosis in 23 (60%) of cases compared with 27 (70%) for the corresponding aspirated marrow smears. Phenotypic analysis using flow cytometry showed persistence of a range of surface membrane antigens following collagenase digestion. Increased autofluorescence was a problem in some cases. Cytochemistry, bone marrow culture, and cytogenetic analysis could also be carried out on these cells. It is concluded that this technique has useful diagnostic applications in cases of dry taps. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--To assess the effects of oral vasodilator treatment on ventricular arrhythmias in acute myocardial infarction. SETTING--Coronary care units at the John Radcliffe Hospital, Oxford, and the Royal Infirmary, Edinburgh. PATIENTS--100 patients with suspected acute myocardial infarction entered the study at a mean of 13 hours from symptom onset. DESIGN OF INTERVENTION--Double blind randomisation to 4 weeks treatment with captopril (12.5 mg three times a day after a 6.25 mg test dose (n = 32)) or isosorbide mononitrate (20 mg three times a day (n = 31)) or placebo control (n = 37). OUTCOME MEASURES--Ventricular arrhythmic events assessed by 48 hours of Holter monitoring starting at the time of randomisation. RESULTS--The number of ventricular extrasystoles/hour for captopril, mononitrate, and placebo was respectively (median and range) 6 (0-162), 4 (0-38), and 10 (0-932) (2p < 0.02 mononitrate v placebo). The number of episodes of multiple extrasystoles/hour was 0.2 (0-22), 0.3 (0-4), and 0.5 (0-19); (2p < 0.02 mononitrate v placebo). Episodes of ventricular tachycardia showed a non-significant decrease in the captopril and mononitrate groups (mean (SEM) 3.2 (0.8), 2.4 (0.7), and 4.7 (1.3) for the 48 hour period). The incidence of idioventricular rhythm was also reduced in both active treatment groups (28%, 19%, and 46% (2p < 0.05 mononitrate v placebo)). CONCLUSIONS--Oral mononitrate (and perhaps also captopril) seems to reduce the incidence of ventricular arrhythmias in the early phase of acute myocardial infarction. The effects on life-threatening arrhythmias, such as ventricular fibrillation, and on death can only be assessed in a much larger trial. [ABSTRACT FROM PUBLISHER]

Consultant physicians and cardiologists were surveyed early in 1987 and 1989 to document the management policies for the treatment of acute myocardial infarction in United Kingdom hospitals and to assess the influence of major clinical trials on these policies. The response rate to both these surveys was high (84% (1178 physicians) in 1987 and 76% (982 physicians) in 1989). The percentage of physicians that reported using antiplatelet therapy "routinely" in acute myocardial infarction rose from 9% in 1987 to 84% in 1989 while those who reported using it "rarely or never" fell from 42% to 3%. Similarly, "routine" use of fibrinolytic therapy rose from 2% to 68%, and use "rarely or never" fell from 53% to 3%. This increase in the reported use of fibrinolytic therapy was accompanied by greater certainty about its efficacy and relative safety and by a general widening of the indications for its use. The use of other treatments in acute myocardial infarction (for example, the general use of anticoagulants, beta blockers, nitrates, calcium antagonists, or prophylactic antiarrhythmic agents) seemed to change little during this period, although the routine use of coronary angiography and oral anticoagulants after fibrinolytic therapy fell substantially between 1987 and 1989 (from 23% to 4%, and from 24% to 7% respectively). Fibrinolytic and antiplatelet therapy were accepted into the routine management of myocardial infarction during a relatively short period that coincided with the reporting of several positive controlled trial results. Clinical trials have rarely been seen to have had such a great impact on practice. In this case the rapid acceptance of the trial results may have been due to the consistency and reliability of the estimates of the size of the benefits (and risks) of therapy seen in these unusually large studies. [ABSTRACT FROM PUBLISHER]

The occurrence of ventricular arrhythmias attributed to streptokinase treatment in acute myocardial infarction is not well defined. Holter monitoring was performed for 24 hours in 81 patients with suspected acute myocardial infarction randomised in a ratio of 2:1 to intravenous streptokinase 1.5 x 10(6) IU (n = 55) or placebo infusion (n = 26) 6.7 hours (mean) after the onset of symptoms. No episodes of ventricular fibrillation were recorded. For the whole 24 hour period and during the first three hours after the start of treatment the incidence and frequency of ventricular arrhythmias were similar in the patients randomised to streptokinase and to placebo. But when the results in patients randomised "early" after the onset of symptoms of suspected acute myocardial infarction were analysed separately the frequency of abnormal complexes, pairs, runs, and repetitive arrhythmias seemed to be higher in patients allocated to streptokinase. This may reflect arrhythmias associated with reperfusion. [ABSTRACT FROM PUBLISHER]

Evidence is presented that lymphocytes characterised by being large and having abundant feebly staining, and usually profusely granulated cytoplasm ('pale' cells) are a group which is distinct from the other small basophilic ('dark') cells. In patients with genetic storage disorders characterised by abnormalities of lymphocyte structure, the structural peculiarites were confined to the basophilic cells, and cytochemical differences were found between the 'pale' and 'dark' cells in normal subjects. [ABSTRACT FROM PUBLISHER]

Morphological and immunological studies of four cases of leukaemic reticuloendotheliosis are reported. The findings indicate that leukaemic reticuloendotheliosis is a monoclonal B cell neoplasm in which the leukaemic cell expresses either Κ or λ light chain and δ heavy chain determinants. The similarity between this disease and chronic lymphocytic leukaemia is discussed. [ABSTRACT FROM PUBLISHER]

Sixteen cases of primary carcinoma of the fallopian tube were diagnosed and treated at Queen Mary Hospital, Hong Kong from July 1972 to June 1992 constituting 0.26% of the total gynecologic malignancies seen during that period. The average age was 61 years and the most common presenting symptom was abnormal vaginal bleeding. Preoperative diagnosis is difficult; in only one case was a diagnosis of malignancy made by cervical smear. An adnexal mass was detected in 13 of the cases (81.3%) either by clinical examination and/or ultrasonography. Therapy consisted of surgical resection, usually followed by various combinations of adjuvant radiation therapy and chemotherapy. The cumulative survival was 62%. In addition to the typical form of adenocarcinoma, one case of squamous cell carcinoma and a case of multifocal endometrioid adenocarcinoma were observed. One case of an apparently usual form of adenocarcinoma recurred as a heterologous malignant mixed Müllerian tumor 2 years after diagnosis. This series further emphasises the wide range of differentiation possible in the Müllerian system and the variety of neoplasms which may arise from it. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of antiplatelet therapy for thromboprophylaxis. Reduction of the thromboembolism with the therapy and with subcutaneous heparin; Effects of the reduction of pulmonary embolism for people at higher risk; Effects of antiplatelet therapy on surgical bleeding.

AIMS--To detect the presence of Epstein-Barr virus (EBV) in cases of vulval carcinoma in Chinese patients living in Hong Kong. METHODS--Formalin fixed, paraffin wax embedded blocks from eight cases of vulval carcinoma and six age matched controls of non-neoplastic vulval tissue were analysed for the presence of EBV DNA using the polymerase chain reaction (PCR). RESULTS--EBV DNA was detected in only one of the eight cases of vulval carcinoma cases while it was detected in four out of the six control cases. CONCLUSIONS--There is no demonstrable association between EBV and vulval carcinoma. Detection of EBV in non-neoplastic vulval epithelium highlights its ubiquitous presence in the lower female genital tract. [ABSTRACT FROM PUBLISHER]

The Kallestad Corporation recently suggested that their new buffer system for the nephelometric detection of rheumatoid factor conferred advantages over existing systems. Two rate nephelometric procedures, the Kallestad QM-300 and the Beckman ICS-II (RF), were therefore compared. Sera (n = 157) were selected on the basis of a previous ICS-II value. The results on the QM-300 of sera with an initial rheumatoid factor value of less than 400 IU identified two groups. Group 1 (n = 109) showed a good correlation with the ICS-II method while group 2 (n = 13) was highly discordant with the QM-300, producing significantly higher values. The values of 35 sera with an initial rheumatoid factor of greater than 400 IU were likewise highly discordant, with the QM-300 producing significantly lower values. Dilution recovery experiments implied that the Beckman buffer was likely to be contributory. As the formulae of the buffers remain proprietary, the reasons for the differences are speculative. The findings could be taken to indicate that the Kallestad value is a more accurate indicator of the quantity of rheumatoid factor than the Beckman value. [ABSTRACT FROM PUBLISHER]

Manual dilatation of the anus was carried out on 50 unpremedicated outpatients under propanidid, nitrous oxide, and halothane anaesthesia with E.C.G.monitoring. About half of the patients received intravenous atropine with the propanidid. The operation induced a variety of changes in heart rate but in the whole experiment only two isolated cardiac arrhythmic complexes were seen—a single defect of conduction and a solitary ventricular extrasystole. Changes in rate were not modified by atropine. It is concluded that manual dilatation of the anus is a safe procedure when carried out under the anaesthetic described and that prior medication with atropine is not necessary. This work supports the view that propanidid protects patients from most abnormalities of heart action which result from intense visceral stimulation. [ABSTRACT FROM PUBLISHER]

This article presents a clinical trial, which proves that withdrawal of benzodiazepines in elderly long term users does not produce significant adverse effects in the short term. Alter six months, successful withdrawal from benzodiazepines, was achieved by 80% of participants, with no significant difference between groups. There was no significant difference between groups in cognition, psychomotor function, mood, somatic symptoms, time spent in bed, number of awakenings per night, or difficulties in steeping by sleep diary at 12 weeks. Quality of life outcomes were similar between groups on SF- 36 subscales.

Background and Purpose: Healthcare systems are challenged to provide access to thrombectomy in acute stroke patients. Either the "drip and ship" or "mothership" models result in increased numbers of patients in the endovascular stroke centre (ESC). We describe our approach for a "drip, ship, retrieve and leave" model repatriating patients immediately or within 24 hours of thrombectomy., Methods: We included consecutive patients who underwent thrombectomy from January 2016 to June 2018. Patients from local region primary stroke centres (PSC) are immediately repatriated and those from remote region PSCs are admitted for 24 hours before repatriation. Key parameters recorded included clinical, radiological and timeline data as well as 90-day modified Rankin Scale (mRS). Patients who stayed beyond the intended time period in the ESC were analysed., Results: From January 2016 to June 2018, 435 patients were transferred, with 352 patients in the local region group and 83 in the remote region group. The median NIHSS was 16 with a median ASPECTS of 9. Good functional outcome was seen in 47% of patients with a mortality rate of 19%. The local region group that were repatriated at the intended time period had a 90-day mRS 0-2 of 47% compared with 20% of those admitted to the ESC (P=0.006). Mortality rates were 20% and 27% respectively (P=0.377). The remote region group, repatriated at 24 hours' post-emergency endovascular thrombectomy had 90-day mRS 0-2 of 65% compared with 41% in the group admitted (P=0.042). Mortality rates were 4% and 22% respectively (P=0.007)., Conclusion: This model enables the treatment of large numbers of patients with large vessel occlusion acute ischaemic stroke with thrombectomy within a national stroke service and system of care which would not otherwise be facilitated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine whether a team illness prevention strategy (TIPS) would reduce the incidence of acute illness during the Super Rugby tournament., Methods: We studied 1340 male professional rugby union player seasons from six South African teams that participated in the Super Rugby tournament (2010-2016). Medical staff recorded all illnesses daily (126 850 player days) in a 3-year control (C: 2010-2012; 47 553 player days) and a 4-year intervention (I: 2013-2016; 79 297 player days) period. A five-element TIPS was implemented in the I period, following agreement by consensus. Incidence rate (IR: per 1000 player days; 95% CI) of all acute illnesses, illness by main organ system, infectious illness and illness burden (days lost due to illness per 1000 player days) were compared between C and I period., Results: The IR of acute illness was significantly lower in the I (5.5: 4.7 to 6.4) versus the C period (13.2: 9.7 to 18.0) (p<0.001). The IR of respiratory (C=8.6: 6.3 to 11.7; I=3.8: 3.3 to 4.3) (p<0.0001), digestive (C=2.5: 1.8 to 3.6; I=1.1: 0.8 to 1.4) (p<0.001), skin and subcutaneous tissue illness (C=0.7: 0.4 to 1.4; I=0.3: 0.2 to 0.5) (p=0.0238), all infections (C=8.4: 5.9 to 11.9; I=4.3: 3.7 to 4.9) (p<0.001) and illness burden (C=9.2: 6.8 to 12.5; I=5.7: 4.1 to 7.8) (p=0.0314) were significantly lower in the I versus the C period., Conclusion: A TIPS during the Super Rugby tournament was associated with a lower incidence of all acute illnesses (59%), infectious illness (49%) and illness burden (39%). Our findings may have important clinical implications for other travelling team sport settings., Competing Interests: Competing interests: CR is the chairman of the South Africa Rugby Football Union Medical Committee., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine the incidence and nature of injuries in the Super Rugby tournament over a 5-year period., Methods: 482 male professional rugby union players from six South African teams participating in the Super Rugby tournament were studied (1020 player-seasons). Medical staff of participating teams (2012-2016 tournaments) recorded all time loss injuries (total injuries and match injuries) and exposure hours (93 641 total playing hours; 8032 match hours). Injury incidence, injured player proportion, severity (time lost), anatomical location, tissue type and activity/phase during which injury occurred are reported., Results: The overall incidence of match injuries (per 1000 player-hours; 95% CI) for each year was as follows: 2012 (83.3; 69.4-99.2); 2013 (115.1; 98.7-133.5); 2014 (95.9; 80.8-113.1), 2015 (112.3; 96.6-129.9) and 2016 (93.2; 79.9-107.9). The injured player proportion for each year was as follows: 2012 (54.6%); 2013 (49.4%); 2014 (52.0%); 2015 (50.0%); and 2016 (39.8%). The thigh, knee, head/face and shoulder/clavicle are the most frequently injured locations, and muscle/tendon and joint/ligament injuries account for the majority of injuries. Most injuries (79%) occur in contact situations, in particular during a tackle (54%)., Conclusion: The incidence of match injuries and the injured player proportion in South African teams competing in the Super Rugby tournament is high. Match injury incidence is consistently higher than previously reported for senior male rugby players at elite/professional level. Targeted risk management strategies are therefore needed in the Super Rugby tournament to manage risk of injury., Competing Interests: Competing interests: CR is the chairman of the South African Rugby Football Union Medical Committee. The other authors declare no conflicts of interest., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Professional Rugby Union is a contact sport with a high risk of injury., Objective: To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament., Design: Prospective cohort study., Setting: 2012 Super Rugby tournament (Australia, New Zealand, South Africa)., Participants: 152 players from 5 South African teams., Methods: Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost)., Results: The proportion (%) of players sustaining a time-loss injury during the tournament was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR/1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the most common mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations ≥6 h time difference)., Conclusions: 55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries/match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for >1 week., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Type XI collagen, which is expressed in developing tendons and is encoded by the COL11A1, COL11A2 and COL2A1 genes, shares structural and functional homology with type V collagen, which plays an important role in collagen fibril assembly. We investigated the association of these three polymorphisms with Achilles tendinopathy (AT) and whether these polymorphisms interact with COL5A1 to modulate the risk of AT., Methods: 184 participants diagnosed with chronic AT (TEN) and 338 appropriately matched asymptomatic controls (CON) were genotyped for the three polymorphisms., Results: Although there were no independent associations with AT, the TCT pseudohaplotype constructed from rs3753841 (T/C), rs1676486 (C/T) and rs1799907 (T/A) was significantly over-represented (p=0.006) in the TEN (25.9%) compared with the CON (17.1%) group. The TCT(AGGG) pseudohaplotypes constructed using these type XI collagen polymorphisms and the functional COL5A1 rs71746744 (-/AGGG) polymorphism were also significantly over-represented (p<0.001) in the TEN (25.2%) compared with the CON (9.1%) group., Discussion: The genes encoding structural and functionally related type XI (COL11A1 and COL11A2) and type V (COL5A1) collagens interact with one another to collectively modulate the risk for AT. Although there are no immediate clinical applications, the results of this study provide additional evidence that interindividual variations in collagen fibril assembly might be an important molecular mechanism in the aetiology of chronic AT.