Testicular torsion and subsequent testicular function in young men from the general population.

STUDY QUESTION: Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? SUMMARY ANSWER: In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. WHAT IS KNOWN ALREADY: Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. STUDY DESIGN, SIZE, DURATION: A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. LIMITATIONS, REASONS FOR CAUTION: A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. WIDER IMPLICATIONS OF THE FINDINGS: Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. STUDY FUNDING/COMPETING INTEREST(S): Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. TRIAL REGISTRATION NUMBER: N/A.

Social media for health promotion in diabetes: study protocol for a participatory public health intervention design.

BACKGROUND: Participatory health approaches are increasingly drawing attention among the scientific community, and could be used for health promotion programmes on diabetes through social media. The main aim of this project is to research how to best use social media to promote healthy lifestyles with and within the Norwegian population. METHODS: The design of the health promotion intervention (HPI) will be participatory, and will involve both a panel of healthcare experts and social media users following the Norwegian Diabetes Association. The panel of experts will agree on the contents by following the Delphi method, and social media users will participate in the definition of the HPI by expressing their opinions through an adhoc online questionnaire. The agreed contents between both parties to be used in the HPI will be posted on three social media channels (Facebook, Twitter and Instagram) along 24 months. The 3 months before starting the HPI, and the 3 months after the HPI will be used as control data. The effect of the HPI will be assessed by comparing formats, frequency, and reactions to the published HPI messages, as well as comparing potential changes in five support-intended communication behaviours expressed on social media, and variations in sentiment analysis before vs during and after the HPI. The HPI's effect on social media users' health-related lifestyles, online health behaviours, and satisfaction with the intervention will be assessed every 6 months through online questionnaires. A separate questionnaire will be used to assess the panel of experts' satisfaction and perceptions of the benefits for health professionals of a HPI as this one. DISCUSSION: The time constraints of today's medical practice combined with the piling demand of chronic conditions such as diabetes make any additional request of extra time used by health care professionals a challenge. Social media channels provide efficient, ubiquitous and user-friendly platforms that can encourage participation, engagement and action necessary from both those who receive and provide care to make health promotion interventions successful.

Nationwide time trends and risk factors for in-hospital falls-related major injuries.

BACKGROUND: Accidental falls during hospitalisation have a range of complications and more information is needed to improve prevention. We investigated patterns of in-hospital fall-related major injuries in the period 2000-2012 and the association between chronic conditions and in-hospital fall-related major injuries. METHODS: Using administrative databases, patients aged 65+ years with in-hospital falls causing fractures or head injuries with need for surgery or intensive observation were identified as cases and were individually matched with five controls. Joinpoint regression was used to examine time trends and conditional logistic regression was used to analyse odds ratio (OR) for in-hospital falls-related major injuries according to a range of comorbidities. RESULTS: Four thousand seven hundred and fifty-four cases were identified from 2000 to 2012 and the most common injury was femur fracture (61.55%). For individuals aged 65-74 and 75+ years, the incidence of in-hospital falls-related major injuries per 100,000 hospital days increased significantly in 2000-2012 (average annual change: 3.2%, CI: 0.6-5.8) and 2007-2012 (average annual change: 11.4%, CI: 5.7-17.5), respectively. Significantly increased OR for in-hospital fall-related major injuries were found for individuals with dementia (OR = 2.34, CI: 1.87-2.92), osteoporosis (OR = 1.68, CI: 1.43-1.99), stroke (OR = 1.63, CI: 1.41-1.88), depression (OR = 1.24, CI: 1.09-1.41), chronic obstructive pulmonary disease (OR = 1.18, CI: 1.01-1.39) and Parkinson disease (OR = 1.17, CI: 1.01-1.34). CONCLUSIONS: In-hospital falls-related major injuries increased significantly during the study period. Elderly with dementia, osteoporosis, stroke, depression, chronic obstructive pulmonary disease and Parkinson disease were associated with increased OR for in-hospital fall-related major injuries. Increased focus on patients with these comorbidities is warranted to decrease the increasing incidence in in-hospital major injuries.

Characterisation of prosthetic feet used in low-income countries.

Eleven kinds of prosthetic feet that were designed for use in low-income countries were mechanically characterised in this study. Masses of the different kinds of prosthetic feet varied substantially. Dynamic properties, including damping ratios and resonant frequencies, were obtained from step unloading tests of the feet while interacting with masses comparable to the human body. Data showed that for walking, the feet can be appropriately modeled using their quasistatic properties since natural frequencies were high compared to walking frequencies and since damping ratios were small. Roll-over shapes, the effective rocker (cam) geometries that the feet deform to under walking loads, were determined using a quasistatic loading technique and a spatial transformation of the ground reaction force's centre of pressure. The roll-over shapes for most of the prosthetic feet studied were similar to the roll-over shape of the SACH (solid-ankle cushioned heel) prosthetic foot. All roll-over shapes showed a lack of forefoot support, which may cause a "drop-off" experience at the end of single limb stance and shorter step lengths of the contralateral limb. The roll-over shapes of prosthetic feet appear useful in characterization of foot function.

Prosthetic foot roll-over shapes with implications for alignment of trans-tibial prostheses.

Roll-over shape is introduced as a significant characteristic of prosthetic feet. The roll-over shapes of the Flexwalk, Quantum, SACH, and SAFE prosthetic feet were determined using three methods; two involving quasi-static loading and one dynamic loading. The results show that foot roll-over shape properties obtained by quasi-static and by dynamic methods are similar. Relationships between foot roll-over shape and the alignment of trans-tibial prostheses are introduced that suggest ways to align trans-tibial prostheses without walking trials and iterations. The relationships may explain what prosthetists attempt to accomplish when they dynamically align a trans-tibial limb. They also explain why prosthetic feet with different mechanical properties usually necessitate different alignments, and may explain why a number of gait studies of trans-tibial amputees do not show major gait differences when walking is executed on various kinds of prosthetic feet.

Alignment of trans-tibial prostheses based on roll-over shape principles.

The authors examined the roll-over shape alignment hypothesis, which states that prosthetic feet are aligned by matching their roll-over shapes with an "ideal" shape. The "ideal" shape was considered to be the roll-over shape of the able-bodied foot-ankle system. An alignment algorithm and computational alignment system were developed to set trans-tibial alignments based on this hypothesis. Three prosthetic feet with considerably different roll-over shapes were either aligned using the alignment system or not aligned (i.e. used previous foot's alignment), and then were aligned by a team of prosthetists. No significant differences were found between roll-over shapes aligned by the computational alignment system and those based on standard clinical techniques (p = 0.944). Significant differences were found between the "no alignment" shapes and the prosthetist alignment shapes (p = 0.006), and between the "no alignment" shapes and the computational alignment system shapes (p = 0.024). The results of the experiment support the hypothesis that the goal of alignment is to match the prosthetic foot's roll-over shape, as closely as possible, with an "ideal" shape. The hypothesis is also supported by its ability to explain the results of previous studies. Using an "ideal" roll-over shape or surface as a goal for prosthetic alignment could lead to a priori alignment, eliminating the need for alignment hardware in some cases. Being able to build the alignment into a prosthesis without special hardware could be beneficial in low-income countries and in the fabrication of lightweight prostheses for the elderly.

A low-dimensional sagittal-plane forward-dynamic model for asymmetric gait and its application to study the gait of transtibial prosthesis users.

This paper presents an extension of a recently developed low-dimensional modeling approach for normal human gait to the modeling of asymmetric gait. The asymmetric model is applied to analyze the gait dynamics of a transtibial prosthesis user, specifically the changes in joint torque and joint power costs that occur with variations in sagittal-plane alignment of the prosthesis, mass distribution of the prosthesis, and roll-over shape of the prosthetic foot being used. The model predicts an increase in cost with addition of mass and a more distal location of the mass, as well as the existence of an alignment at which the costs are minimized. The model's predictions also suggest guidelines for the selection of prosthetic feet and suitable alignments. The results agree with clinical observations and results of other gait studies reported in the literature. The model can be a useful analytical tool for more informed design and selection of prosthetic components, and provides a basis for making the alignment process systematic.

Phosphorylation of pRb by cyclin D kinase is necessary for development of cardiac hypertrophy.

OBJECTIVES: A number of stimuli induce cardiac hypertrophy and may lead to cardiomyopathy and heart failure. It is believed that cardiomyocytes withdraw from the cell cycle shortly after birth and become terminally differentiated. However, cell cycle regulatory proteins take part in the development of hypertrophy, and it is important to elucidate the mechanisms of how these proteins are involved in the hypertrophic response in cardiomyocytes. MATERIALS AND METHODS, AND RESULTS: In the present study, by immunohistochemistry with a phosphorylation-specific antibody, we found that cyclin D-cdk4/6-phosphorylated retinoblastoma protein (pRb) during hypertrophy and expression of an unphosphorylatable pRb mutant impaired hypertrophic growth in cardiomyocytes. Transcription factor E2F was activated by hypertrophic elicitors but activation was impaired by pharmacological inhibition of cyclin D-cdk4/6. Inhibition of cyclin E-cdk2 complex only partly impaired E2F activity and did not prevent hypertrophic growth, but diminished endoreplication during hypertrophy. CONCLUSIONS: These results indicate that cyclin D-cdk4/6-dependent phosphorylation of pRb and activation of E2F is necessary for hypertrophic growth in cardiomyocytes, whereas cyclin E-cdk2 kinase is not necessary for hypertrophy but regulates endoreplication in these cells. The data support the notion that hypertrophic growth of cardiomyocytes involves a partial progression through the G1 phase of the cell cycle

[Student education in a laboratory for general practice skills]. / Studentundervisning i allmennmedisinsk ferdighetslaboratorium.

Clinical skills, like questioning and examining a patient, are developed gradually throughout the years of medical training. Basic skills should be mastered on graduation, but the teaching of skills in most medical schools is not systematic. We evaluated a pilot teaching project in a general practice (GP) skills laboratory. Students were randomised to an intervention group and a control group. Teaching was performed in small groups of one GP instructor and six students and consisted of four weekly three-hour sessions. For the control group, teaching was delayed until after evaluation. Evaluation of practical skills and communication skills was made with the students in random order by GP evaluators who did not know about the randomisation procedure. Each skill was scored as satisfactory or not satisfactory for each of five procedural elements. 56 fourth-year medical students volunteered. Evaluation was performed for 19 (68%) students in the training group and 18 (64%) in the control group. The training group performed better on practical skills, average score 9.7 (95% confidence interval 7.4 to 12.1) vs. 5.5 (3.2 to 7.8), (p = 0.01). There was no significant difference for communication skills, 7.7 (5.6 to 9.8) vs. 6.7 (4.6 to 8.7). Teaching clinical skills in a general practice skills laboratory is feasible. Practical skills may improve rapidly, at least for short-time performance, while our brief teaching in communication skills was not proved to be effective.

Outbreak of Salmonella typhimurium infection traced to contaminated chocolate and caused by a strain lacking the 60-megadalton virulence plasmid.

We describe an outbreak of Salmonella typhimurium infection, caused by contaminated chocolate produced by one Norwegian company, which occurred in Norway and Finland in 1987. A total of 349 bacteriologically verified cases were recorded in Norway, and 12 cases were recorded in Finland. There was a predominance of young children among the patients (median age, 6 years), many of whom developed acute hemorrhagic diarrhea. The outbreak strain exhibited a rare phage lysis pattern and a characteristic plasmid profile lacking the 60-MDa virulence-associated plasmid. DNA hybridization failed to demonstrate any DNA sequence homology between the outbreak strain and the virulence plasmid. The outbreak strain was nonlethal for orally infected mice. The finding of only less than or equal to 10 S. typhimurium cells per 100 g of chocolate in about 90% of the positive samples obtained from retail outlets suggested that an inoculum of fewer than 10 organisms may have been sufficient to cause symptomatic disease.