Objective Rock climbing is a widely performed sport. This prospective single-institution study evaluated the demographics of climbing-related injuries to improve our comprehension of current injury ...characteristics. Methods During a 4-year period, 836 patients with a total of 911 independent climbing injuries were prospectively evaluated using a standard questionnaire and examination protocol. Results Of all injuries, 833 were on the upper extremities, 58 on the lower. Seventeen injuries were Union International des Associations d’Alpinisme (UIAA) grade 1 injuries, 881 were grade 2, and 13 were grade 3. No higher UIAA graded injuries occurred. Overall, 380 were acute injuries (359 were seen in clinic, 21 were seen through the emergency department), and 531 were overstrain injuries (all seen in clinic). Finger injuries accounted for 52% of all injuries, the shoulder being the second most frequent location. Pulley injuries were the most frequent finger injuries. Of 20 injured young climbers under the age of 15 years, 14 had an epiphyseal fracture (all epiphyseal fractures: mean age 14 years, range 12 to 15 years). Male climbers were significantly older ( P < .05), had more climbing years ( P < .05), and were climbing at a higher climbing level ( P < .01). Older, more experienced climbers had significantly more overstrain injuries than acute injuries ( P < .05). Conclusions When comparing this study with our previous study from 1998 to 2001, there are some notable differences. Although pulley injuries are still the most common climbing injury, there are now more A4 pulley injuries than A2. Shoulder injuries are becoming more common, as are epiphyseal fractures among young climbers. It is important to understand current patterns of climbing injuries so that health providers can target interventions appropriately.
Background Cutaneous lymphocyte-associated antigen (CLA) is a surface glycoprotein expressed by skin-homing T cells. This carbohydrate moiety expressed on mucin-like surface glycoproteins, including ...P-selectin glycoprotein ligand 1 and CD43, confers binding activity to dermal endothelial E-selectin and is critical for T-cell recruitment to the skin. Vitamin A (retinoic acid RA) and the active form of vitamin D3 (1,25 dihydroxyvitamin D3 1,25D(3)) have been used to treat certain T cell–mediated inflammatory skin diseases, as well as cutaneous T-cell lymphomas; however, their effect on CLA expression has not been studied. Objective We analyzed the effects of RA and 1,25D(3) on expression of CLA and other lymphocyte-homing receptors on human T cells. Methods We cultured human T cells with 1,25D(3) and RA and analyzed the expression of CLA and other homing receptors. We also pretreated mice with either vitamin and then induced an antigen-dependent contact hypersensitivity response. Results Both RA and 1,25D(3) downregulated expression of the CLA and, in parallel, functional E-selectin ligand. Whereas RA increased expression of the gut-homing receptor α4β7 and reduced L-selectin expression, 1,25D(3) had no effect on other homing receptors. In an in vivo assay treatment with RA or 1,25D(3) downregulated the skin infiltration of effector CD4+ T cells. Conclusion These findings suggest that 1,25D(3) can selectively downregulate CLA expression without influencing lymphocyte migration patterns to other tissues.
Objective Rock climbing’s popularity continues to rise, with people of all ages regularly participating in the sport. Climbing literature suggests climbers get injured mostly in their upper ...extremities. Most studies on climbing injury analysis are conducted retrospectively, with all the inherent problems of a retrospective setup (no exact time collection, biased injury perception, etc). Prospective data are still missing. Methods We prospectively evaluated all attendees of a major German indoor climbing gym in Stuttgart, Germany, with bouldering and lead climbing facilities. Attendee’s age, sex, and time spent climbing were electronically recorded on each visit. All acute injuries were graded using the Medical Commission of the Union Internationale des Associations d’Alpinisme Score. Injury cause, belayers’ and climbers’ experience, and outcome were additionally analyzed. Results During a 5-year period (2007–2011), 515,337 visits to the climbing wall were registered, of which 63.6% were by male visitors, 36.4% female, within an age of 8–80 years (median, 34 years). The average time of climbing was 2 hours 47 minutes. Thirty climbing injuries were recorded, 22 were in male and 8 in female climbers with a total mean age of 27.5 ± 10.6 years. Acute injuries happened in 6 cases while bouldering, in 16 cases while lead climbing, in 7 cases while top roping, and in 1 case as a third person (not climbing or belaying) while watching another climber. Bouldering injuries were mostly the result of falls onto the mat, whereas in lead and top rope climbing various scenarios happened. Fifteen (50%) injuries were Medical Commission of the Union Internationale des Associations d’Alpinisme grade 2, 13 (43%) were grade 3, and 2 (7%) were grade 4, with no fatalities. The overall injury rate was 0.02 injuries per 1000 hours of climbing activities. Conclusions This was the first study to accurately record time spent indoor climbing digitally and evaluate the acute injuries prospectively in a large cohort. There were few injuries sustained, suggesting indoor climbing has a low risk of acute injury per 1000 hours of participation. The injuries were of minor to moderate injury severity, and no fatalities occurred. Several injuries could have been avoided, and further injury-prevention concepts should be developed.
Background The use of many of the standard skin-directed mycosis fungoides (MF) therapies on facial skin may be limited by site-specific increased risks of side effects, excessive inflammation, and ...ocular toxicity. Objective Our study aimed to describe the levels of erythema, scale, and induration of facial lesions in MF before and after low-dose high-dose-rate surface applicator brachytherapy and to examine the overall clinical response to brachytherapy. Methods A total of 23 facial MF lesions in 10 patients were treated with high-dose-rate brachytherapy doses of 4 Gy per session for a total of 2 fractions at our multidisciplinary cutaneous oncology clinic between August 17, 2009, and March 12, 2012. Results In all 23 lesions, dramatic clinical improvement was observed. Patients were followed up for a median of 6.3 months. No recurrences were reported in the follow-up period. Limitations Long-term follow-up is lacking. Reassessment of all included patients at annual intervals for a period of at least 5 years is the authors' goal. Conclusion Low-dose high-dose-rate brachytherapy using custom-made surface molds is a highly efficacious therapy in the treatment of facial lesions in MF.
PDF
