Dislocation of hemiarthroplasty after hip fracture is common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register.

Background and purpose - Reported revision rates due to dislocation after hemiarthroplasty span a wide range. Dislocations treated with closed reduction are rarely reported despite the fact that they can be expected to constitute most of the dislocations that occur. We aimed to describe the total dislocation rate on the national level, and to identify risk factors for dislocation.Patients and methods - We co-processed a national cohort of 25,678 patients in the Swedish Hip Arthroplasty Register, with the National Patient Register (NPR) and Statistics Sweden. Dislocation was defined as the occurrence of any ICD-10 or procedural code related to hip dislocation recorded in the NPR, with a minimum of 1-year-follow-up. In theory, all early dislocations should thereby be traced, including those treated with closed reduction only.Results - 366/13,769 (2.7%) patients operated on with direct lateral approach dislocated, compared with 850/11,834 (7.2%) of those with posterior approach. Posterior approach was the strongest risk factor for dislocation (OR = 2.7; 95% CI 2.3-3.1), followed by dementia (OR = 1.3; CI 1.1-1.5). The older the patients, the lower the risk of dislocation (OR = 0.98 per year of age; CI 0.98-1.0). Neither bipolar design nor cementless stems influenced the risk.Interpretation - The choice of posterior approach and dementia was associated with an increased dislocation risk. When hips treated with closed reduction were identified, the frequency of dislocation with use of direct lateral and posterior approach more than doubled and tripled, respectively, compared with when only revisions due to dislocation are measured.

More hip complications after total hip arthroplasty than after hemi-arthroplasty as hip fracture treatment: analysis of 5,815 matched pairs in the Swedish Hip Arthroplasty Register.

Background and purpose - Total hip arthroplasty (THA) is increasing as treatment of displaced femoral neck fractures. Several studies compare hemiarthroplasty (HA) with THA, but results vary and few studies report on medical complications. We examined the outcome of THA and HA with a focus on medical complications, hip complications, and death.Patients and methods - Data from the Swedish Hip Arthroplasty Register on 30,953 acute hip fracture patients treated with cemented THA or HA in 2005-2011 were cross-matched with Statistics Sweden for socioeconomic data and with the National Patient Register for diagnostic codes representing medical complications within 180 days or hip complications within the study period. Propensity score matching was used to create comparable groups based on age, sex, income, level of education, marital status, Elixhauser index, and year of surgery. Logistic regression models were created for each outcome.Results - 81% were treated with HA, 73% and 71% were female (HA and THA respectively). Matching resulted in 2 groups of 5,815 patients each. THA was associated with fewer medical complications (OR = 0.83; 95% CI 0.76-0.91) and lower 1-year mortality (OR = 0.42; CI 0.38-0.48), but more hip complications (OR = 1.31; CI 1.20-1.43).Interpretation - THA as treatment of hip fracture was associated with more hip-related complications than HA. The results on mortality and medical complications are, rather, influenced by residual confounding than by the implant design per se. An expansive use of THAs for hip fracture treatment, at the expense of HAs, is not recommended based on our findings if hip complications are to be avoided.

Reduced risk of reoperation after treatment of femoral neck fractures with total hip arthroplasty.

Background and purpose - Femoral neck fractures (FNFs) are commonly treated with some kind of arthroplasty, but evidence on whether to use hemiarthroplasty (HA) or total hip arthroplasty (THA) is lacking. HA reduces the risk of dislocation, but may lead to acetabular erosion. THA implies longer surgery and increased bleeding. THA may result in better function and health-related quality of life, but evidence is contradictory. We compared HA and THA and in terms of revision, reoperation and death. Patients and methods - Data were extracted from the Swedish Hip Arthroplasty Register for 11,253 patients with acute FNF receiving cemented HA or THA during 2008-2012. 2,902 patients with THA were matched by propensity score matching with as many patients with HA based on age, sex, BMI, and ASA classification. We used competing risks survival regression with reoperation or death and revision or death as endpoints. Results - THA patients had significantly reduced risk of revision (absolute risk reduction 0.51; 95% CI 0.39-0.67) and reoperation (0.58; 0.46-0.74). THA was associated with an almost 50% reduced mortality (risk ratio as competing risk for reoperation 0.51; 0.46-0.57). Interpretation - In our national register study of femoral neck fractures, THA had a lower risk than HA for further surgical procedures related to the hip. The reasons for lower mortality after THA are not known. Despite matching, there might be a selection of more healthy patients for this procedure, and other factors unknown to us, with or without relation to the choice of implant.

Positron emission tomography/computed tomography and biomarkers for early treatment response evaluation in metastatic colon cancer.

BACKGROUND: Treatment options for metastatic colon cancer (mCC) are widening. We prospectively evaluated serial 2-deoxy-2-[18F]fluoro-d-glucose positron-emission tomography/computed tomography (PET/CT) and measurements of tissue inhibitor of metalloproteinases-1 (TIMP-1), carcinoembryonic antigen (CEA), and liberated domain I of urokinase plasminogen activator receptor (uPAR(I)) for early assessment of treatment response in mCC patients. METHODS: Thirty-three mCC patients scheduled for first-line chemotherapy with capecitabine and oxaliplatin (CAPOX) and bevacizumab participated; 27 were evaluated by PET/CT before treatment, after one and four treatment series. Morphological and metabolic response was independently assessed according to Response Evaluation Criteria in Solid Tumors and European Organization for Research and Treatment of Cancer PET criteria. Plasma TIMP-1, plasma uPAR(I), and serum CEA were determined. RESULTS: Metabolic response after one treatment course predicted the ability of CAPOX and bevacizumab to induce morphological response after four treatment series with a sensitivity of 80%, specificity of 69%, and odds ratio of 13.9 (95% confidence interval [CI] 1.9; 182). Early metabolically stable or progressive disease was associated with shorter progression-free survival (hazard ratio [HR] = 3.2 [CI 1.3; 7.8]). Biomarker levels at early evaluation were associated with shorter OS (TIMP-1 per unit increase on a log-2-transformed ng/mL scale: HR = 2.6 [CI 1.4; 4.9]; uPAR(I) per 25 fmol/mL increase: HR = 1.5 [CI 1.1; 2.1]). CONCLUSION: This monocentric study demonstrated predictive value of early metabolic PET response and prognostic value of TIMP-1 and uPAR(I) levels in mCC treated with CAPOX and bevacizumab. Results support investigation of PET/CT, TIMP-1, and uPAR(I) guided early treatment adaptation in mCC.

Grafting efficiency of synthetic polymers onto biomaterials: a comparative study of grafting-from versus grafting-to.

In the present study, the two grafting techniques grafting-from - by activators regenerated by electron transfer atom transfer radical polymerization (ARGET ATRP) - and grafting-to - by copper(I)-catalyzed azide-alkyne cycloaddition (CuAAC) - were systematically compared, employing cellulose as a substrate. In order to obtain a meaningful comparison, it is crucial that the graft lengths of the polymers that are grafted from and to the substrates are essentially identical. Herein, this was achieved by utilizing the free polymer formed in parallel to the grafting-from reaction as the polymer for the grafting-to reaction. Four graft lengths were investigated, and the molar masses of the four free polymers (21 ≤ M(n) ≤ 100 kDa; 1.07 ≤ D(M) ≤ 1.26), i.e. the polymers subsequently employed in the grafting-to reaction, were shown to be in the same range as the molar masses of the polymers grafted from the surface (23 ≤ M(n) ≤ 87 kDa; 1.08 ≤ D(M) ≤ 1.31). The molecular weights of the chains grafted from the surface were established after cleavage from the cellulose substrates via size exclusion chromatography (SEC). High-resolution Fourier transform infrared microscopy (FT-IRM) was employed as an efficient tool to study the spatial distribution of the polymer content on the grafted substrates. In addition, the functionalized substrates were analyzed by X-ray photoelectron spectroscopy (XPS), contact angle (CA) measurements, and field-emission scanning electron microscopy (FE-SEM). For cellulose substrates modified via the grafting-from approach, the content of polymer on the surfaces increased with increasing graft length, confirming the possibility to tailor not only the length of the polymer grafts but also the polymeric content on the surface. In comparison, for the grafting-to reaction, the grafted content could not be controlled by varying the length of the preformed polymer: the polymer content was essentially the same for the four graft lengths. Consequently, the obtained results, when employing cellulose as a substrate and under these conditions, suggest that the grafting-from approach is superior to the grafting-to technique with respect to controlling the distribution of the polymeric content on the surface.

Socio-Demographics, Pain Characteristics, Quality of Life and Treatment Values Before and After Specialized Interdisciplinary Pain Treatment: Results from the Danish Clinical Pain Registry (PainData).

BACKGROUND AND AIMS: PainData is an electronic internet-based clinical pain registry established to improve the understanding and treatment of high-impact chronic pain. The primary aim of this paper is to describe socio-demographics, pain characteristics, quality of life, and treatment values at baseline and follow-up in individuals referred to public and private interdisciplinary pain centers in Denmark between 2018 and 2020. METHODS: Self-reported patient-reported outcomes collected through PainData before (n=12,257) and after (n=4,111) treatment across 13 public and private interdisciplinary specialized pain centers in Denmark (87% of all pain centers in Denmark) are described. RESULTS: Mean duration of pain was 10 years, and one in three patients reported chronic widespread pain. More than 40% reported opioid use, and 50% had tried four or more different treatment modalities prior to referral. More than 60% reported poor sleep, severe fatigue, and memory and/or concentration deficits. Mean scores on pain catastrophizing, fear of movement, and pain-related disability were high, whereas scores on pain acceptance and self-efficacy were low. Physical and mental health were rated as poor and fair, respectively. One in four patients reported being very much improved or much improved after treatment. Items commonly reported after treatment were increased knowledge about pain, emotions and mood (66.5%), being better at accepting life with chronic pain (63.1%), and improved activity pacing (60.6%). CONCLUSION: The PainData registry, containing data from a large cohort of individuals, can help to improve the understanding and treatment of high-impact chronic pain, and collaborations with other researchers are welcome.

Magnetic resonance imaging for verifying hip fracture diagnosis why, when and how?

INTRODUCTION: Hip fractures are commonly diagnosed by plain radiography. When a patient presents with negative radiographs and high clinical suspicion of fracture, guidelines recommend proceeding with magnetic resonance imaging (MRI) to diagnose the patient. The aim of this study was to assess the use of MRI in diagnosing hip fractures following trauma to the hip and describe clinical outcome after MRI-diagnosed hip fractures. The perspective was to develop new recommendations for MRI use. MATERIALS AND METHODS: 616 patients at a university hospital fulfilled the inclusion criteria of having an MRI scan of the hip following trauma between the years of 2005 and 2014. Data was collected from the patients' medical records. RESULTS: The annual number of MRIs increased over the ten-year period. Out of 616 MRI scans 228 (37%) showed fracture of the hip with a dominance of trochanteric fractures, 185 (30%) revealed pelvic fracture and 183 (29%) were negative. No patient with acute pelvic fracture had associated fracture of the hip. The main reason to proceed with MRI was a strong clinical suspicion of fracture in patients with negative initial radiographs. Amongst the 228 patients with fracture, 187 (82%) were treated operatively. Of patients with hip fracture, 90 (39%) patients suffered a general complication and 11 (5%) had hip complications. The complication rate of patients with fracture on MRI was compared to that of a cohort of general hip fracture patients at our hospital. No significant difference in twelve months' survival or general complications could be found, but the MRI group had a significantly lower hip complication rate. CONCLUSION: The diagnosis set by MRI, with high share of pelvic fractures or no fracture, reflects the difficulty in differential diagnosing this group of patients. The rate of occult hip fractures was low and patients with pelvic fractures already known from X-ray did not have additional hip fractures. We found an increase in the annual number of MRIs during the 10-year-period. MRI-diagnosed hip fracture patients do not suffer more complications than the regular hip fracture patient.

Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging.

UNLABELLED: The aim of this study was to evaluate the assessment of the left ventricular ejection fraction (LVEF) in patients by gated IQ-SPECT. METHODS: Twenty-eight patients were examined using gated (99m)Tc-sestamibi IQ-SPECT. Two different reconstruction datasets were created using the same projection data. The number of iterations, subsets, and gaussian filtering were based on 2 different recommendations from the manufacturer. For each dataset, end diastolic volume, end systolic volume, and LVEF were calculated using 4DMSPECT. A multigated planar equilibrium radionuclide ventriculography (MUGA) study with (99m)Tc-labeled red blood cells was used as a reference for the LVEF. RESULTS: The values of the different datasets were tested using the Bland-Altman analysis method. The calculated mean and 95% limits of agreement for the LVEF when dataset 1 and 2 were compared were -1.1% and ±15% points; when dataset 1 was compared with MUGA, the mean was calculated to -3.1% points and ±17% points for the 95% limits of agreement. When dataset 2 and MUGA were compared, the mean was -4.2% and 95% limits of agreement of ±18% points. CONCLUSION: Neither of the gated reconstructed datasets analyzed with 4DMSPECT was comparable to LVEF estimated by MUGA, with a tendency to overestimate LVEF. However, large random variations of the end diastolic volume, end systolic volume, and LVEF between the 2 gated reconstructed datasets were found. The reconstructed datasets were not interchangeable. Thus, these values should only be used with great caution when evaluating the functional state of the heart.

Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients.

INTRODUCTION: The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. METHODS: All patients (>20 years, non-pathological fracture, residents in the catchment area, n=664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. RESULTS: The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24h, p<0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. CONCLUSION: General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process.

FDG-PET/CT in Infectious and Inflammatory Diseases.

Nuclear medicine techniques have been an integral part of infection and inflammation imaging for decades; in recent years, fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has taken over many indications. This review provides a comprehensive overview of the current and potential applications for FDG-PET/CT in infectious and inflammatory diseases (ie, systemic infections, bone infections, vascular infection and inflammation, thoracic and abdominal inflammation) and potential novel applications in both infection and inflammation.

ARGET ATRP for versatile grafting of cellulose using various monomers.

In recent years, cellulose-based materials have attracted significant attention. To broaden the application areas for cellulose, polymers are often grafted to/from the surface to modify its properties. This study applies ARGET (activators regenerated by electron transfer) ATRP (atom transfer radical polymerization) when straightforwardly grafting methyl methacrylate (MMA), styrene (St), and glycidyl methacrylate (GMA) from cellulose in the form of conventional filter paper in the presence of a sacrificial initiator. The free polymer, formed from the free initiator in parallel to the grafting, was characterized by (1)H NMR and SEC, showing that sufficient control is achieved. However, the analyses also indicated that the propagation from the surface cannot be neglected compared to the propagation of the free polymer at higher targeted molecular weights, which is an assumption often made. The grafted filter papers were evaluated with FT-IR, suggesting that the amount of polymer on the surface increased with increasing monomer conversion, which the FE-SEM micrographs of the substrates also demonstrated. Water contact angle (CA) measurements implied that covering layers of PMMA and PS were formed on the cellulose substrate, making the surface hydrophobic, in spite of low DPs. The CA of the PGMA-grafted filter papers revealed that, by utilizing either aprotic or protic solvents when washing the substrates, it was possible to either preserve or hydrolyze the epoxy groups. Independent of the solvent used, all grafted filter papers were essentially colorless after the washing procedure because of the low amount of copper required when performing ARGET ATRP. Nevertheless, surface modification of cellulose via ARGET ATRP truly facilitates the manufacturing since no thorough freeze-thaw degassing procedures are required.