No abstract

We determined the incidence of soft-tissue/musculoskeletal injury occurring during 8,076 recruit-months at risk among recruits undergoing basic training at Marine Corps Recruit Depot, San Diego, California, between January and April 1990. We analyzed International Classification of Disease codes relating to initial visit for injuries, and calculated recruit-months from weekly strength figures. Training-related injuries occurred at a rate of 19.9 injuries per 100 recruit-months. Within the sports medicine clinic, iliotibial band syndrome (22.4%), patellar tendinitis (15.1%), and mechanical low back pain (11.4%) occurred most frequently, with rates per 100 recruit-months of 2.1, 1.4, and 1.1, respectively.

Testing emerging technologies involves the evaluation of biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. The objective of this study was to select an effective classification algorithm for optical spectroscopy as an adjunct to colposcopy and obtain preliminary estimates of its accuracy for the detection of CIN 2 or worse. We recruited 1,000 patients from screening and prevention clinics and 850 patients from colposcopy clinics at two comprehensive cancer centers and a community hospital. Optical spectroscopy was performed, and 4,864 biopsies were obtained from the sites measured, including abnormal and normal colposcopic areas. The gold standard was the histologic report of biopsies, read 2 to 3 times by histopathologists blinded to the cytologic, histopathologic, and spectroscopic results. We calculated sensitivities, specificities, receiver operating characteristic (ROC) curves, and areas under the ROC curves. We identified a cutpoint for an algorithm based on optical spectroscopy that yielded an estimated sensitivity of 1.00 [95% confidence interval (CI) 5 0.92-1.00] and an estimated specificity of 0.71 [95% CI 5 0.62-0.79] in a combined screening and diagnostic population. The positive and negative predictive values were 0.58 and 1.00, respectively. The area under the ROC curve was 0.85 (95% CI 5 0.81-0.89). The per-patient and per-site performance were similar in the diagnostic and poorer in the screening settings. Like colposcopy, the device performs best in a diagnostic population. Alternative statistical approaches demonstrate that the analysis is robust and that spectroscopy works as well as or slightly better than colposcopy for the detection of CIN 2 to cancer.Cervical cancer remains a major cause of morbidity and mortality in the developing world, where 85% of cancers arise. 1,2 Identification of cancerous and precancerous lesions at earlier stages, when interventions are more likely to be effective, is critical for effective cancer control. [3][4][5][6] Recent advances in fiber-optic and semiconductor technologies have enabled the development of a new generation of inexpensive, miniature optical sensors that can probe the interaction of light with potentially cancerous tissue in real-time. 7,8 Work to integrate this new technology with existing detection modalities and clinical screening efforts is ongoing.

No abstract

Fluorescence spectroscopy is a promising technology for detection of epithelial precancers and cancers. In preparation for a multicenter phase II screening trial, a pilot trial was conducted to test data collection and patient examination procedures, use data forms, time procedures, and identify problems with preliminary data analysis. Women 18 years of age and older underwent a questionnaire, a complete history, and a physical examination, including a pan-colposcopy of the lower genital tract. A fiber-optic probe measured fluorescence excitation-emission matrices at 1-3 cervical sites for 58 women. The data collection procedures, data forms, and procedure times worked well, although collection times for all the clinical data take an average of 28 min. The clinical team followed procedures well, and the data could be retrieved from the database at all sites. The multivariate analysis algorithm correctly identified squamous normal tissue 99% of the time and columnar normal tissue only 7%. The assessment of ploidy from monolayer samples was not accurate in this small sample. The study was successful as a pilot trial. We learned who participated, who withdrew, how often abnormalities were present, and that algorithms that have worked extremely well in previous studies do not work as well when a few study parameters are changed. The current algorithm for diagnosis identified squamous normal tissue very accurately and did less well for columnar normal tissue. Inflammation may be an explanation for this phenomenon. Fluorescence spectroscopy is a promising technology for the detection of epithelial precancers and cancers. The screening trial of fluorescence and reflectance spectroscopy was successful.