Importance of patellofemoral and tibiofemoral cartilage lesions on trajectory of self-reported outcomes in patients at high risk of knee OA: 4-6 years follow-up of patients undergoing meniscal surgery.

OBJECTIVE: We evaluated whether patient-reported outcome trajectories (i.e., changes over time) differed by intraoperative compartmental cartilage lesion pattern over 4-6 years following arthroscopic meniscal surgery. METHODS: In this ancillary study of the Knee Arthroscopy Cohort Southern Denmark cohort, we intraoperatively categorized cartilage lesions as isolated patellofemoral, isolated tibiofemoral, or combined patellofemoral/tibiofemoral. Participants completed the Knee injury and Osteoarthritis Outcome Score (KOOS) pre-operatively, at 3 and 12 months, and at 4-6 years post-operatively and reported overall satisfaction at final follow-up. Our main outcome was KOOS4 (grand mean of four subscale means). We evaluated whether KOOS4 scores changed over time according to cartilage lesion patterns using adjusted mixed linear regression. We also estimated probability of treatment satisfaction using logistic regression. RESULTS: Of 630 participants with complete cartilage scores, 280 (44%) were women, mean (standard deviation) age was 49 (13) years, and BMI was 27.3 (4.4) kg/m2. KOOS4 scores at baseline were slightly lower in all lesion groups compared to the no lesion group, yet only the combined group was statistically significantly lower. KOOS4 trajectories were similar across cartilage lesion patterns, but by final follow-up, adjusted mean KOOS4 scores were 6.8 (95% CI 2.2, 11.4) to 9.8 (1.1, 18.5) points lower in groups with cartilage lesions compared to the no lesion group. Probability of patient-reported satisfaction did not differ statistically by group. CONCLUSIONS: Though KOOS4 scores were slightly lower in groups with arthroscopically assessed cartilage lesions compared to the no lesion group, trajectories were similar across all groups.

Laminar airflow decreases microbial air contamination compared with turbulent ventilated operating theatres during live total joint arthroplasty: a nationwide survey.

BACKGROUND: Preventing surgical site infections and prosthetic joint infections is crucial for patient safety after total joint arthroplasty. Microbial air contamination has been suggested as a risk factor. Therefore, the ventilation system that will reduce air contamination most effectively in operating theatres (OTs) has been discussed. AIM: To determine whether laminar airflow (LAF) ventilation is superior to turbulent airflow (TAF) ventilation by looking at the colony forming units (cfu) count during live total hip and knee arthroplasties. Furthermore, to explore whether the number of OT personnel, door and cabinet lock openings and technical parameters of the ventilation systems have an impact on the number of cfu. METHODS: Active air sampling and passive sedimented bacterial load were performed in 17 OTs, equipped with either LAF or TAF ventilation, during 51 live surgeries while observations were noted. FINDINGS: LAF OTs reduced cfu counts compared with TAF OTs during live surgery (P<0.001). All LAF OTs provided ultraclean air whereas TAF had nine procedures exceeding the threshold of 10 cfu/m3. Door and cabinet lock openings and number of personnel did not influence the cfu count, while it decreased with increasing volume and total air change per hour (P<0.05). CONCLUSION: All LAF OTs had cfu counts within recommendations and provided lower cfu counts compared with TAF OTs. The number of OT personnel and total openings did not have an influence on cfu counts. Increased volume of the OT and total air change per hour showed a decrease in active cfu counts.

A simplified method to estimate Diphyllobothrium spp. infection in salmonids.

Some fish parasites constitute severe management problems as they may cause mortality of their fish host or are important zoonoses of humans. Parasite assessments are therefore critical to keep track of infections. If conventional sampling techniques can be simplified, parasite assessments might be easier to obtain, less time-consuming and more extensive. In this study, we compare the assessed number of Diphyllobothrium spp. cysts (CYST) with the counted number of Diphyllobothrium spp. plerocercoid larvae recovered using a conventional digestive technique (LARV). The aim was to determine the potential of using CYST as a simplified methodology for assessing Diphyllobothrium spp. infection in salmonids. In total, 365 brown trout and 424 Arctic charr were sampled from nine lakes in subarctic Norway. Strong correlation, significant linear relationship and large amount of explained variation were found between log10 CYST and log10 LARV in both fish species. The method had a slight, but not significant tendency to work better in charr compared to trout. In addition, absolute difference between CYST and LARV increased at parasite intensities >100 indicating that the method has reduced functionality when estimating parasite intensity in heavily infected salmonid populations. However, overall, using this simplified and less time-consuming methodology, a good indication of Diphyllobothrium spp. intensity, abundance and prevalence was obtained. We suggest that this method provides a sound proxy of the Diphyllobothrium spp. burden and have the potential to be used in parasite assessment during fish monitoring and fisheries management surveys, particularly if the time and resources for detailed parasite studies are not available.

[PARASITES FAUNA OF THE LAKE KRONOTSKOE CHARRS (SALVELINUS), KAMCHATKA].

The new data on the parasites fauna of the Lake Kronotskoe sympatric charr forms (genus Salvelinus (Nilsson) Richardson, 1836) is presented. Parasites fauna of Bigmouth and Smallmouth charr forms are described for the first time. The information about Longhead charr, Nosed charr and White charr parasites is added. 29 species of parasites from 9 classes were found: Oligohymenophorea, Myxosporea, Monogenea, Trematoda, Cestoda, Nematoda, Acantocephala, Crustacea and Hirudinea. Longhead charr was the most intensively infected by Proteocephalus longicollis (Zeder, 1800) (abundance 306.0) and Neoechinorhynchus salmonis Ching, 1984 (abundance 230.0). White charr was mostly infected by Crepidostomum Braun, 1900 (abundance 242.2) and P. longicollis (abundance 183.4). Nosed charr group that feed on gammarids was infected mostly by Crepidostomum spp. (abundance 3461.3), Cyathocephalus truncatus (Pallas, 1781) (abundance 179.9) and Cystidicola farionis Fisher, 1798 (abundance 169.0); while Chironomidae consumers group was infected mostly by Diplostomum Nordmann, 1832 (abundance 62.3) and Phyllodistomum umblae (Fabricius, 1780) (abundance 27.3). Bigmouth charr was infected mostly by P. longicollis (abundance 17.0) and Eubolhrium salvelini Schrank, 1790 (abundance 11.0), Smallmouth charr form ­ by P. longicollis (abundance 67.0) and Diplostomum sp. (abundance 64.2). Sympatric flock of charrs form the Lake Kronotskoe (Kamchatka) is the most polymorphic for the genus Salvelinus in Eurasia. According to the parasitological analysis this flock consists six ecological forms.

Parallel evolution of ecomorphological traits in the European whitefish Coregonus lavaretus (L.) species complex during postglacial times.

The extensive phenotypic polymorphism in the European whitefish has triggered evolutionary research in order to disentangle mechanisms underlying diversification. To illuminate the ecological distinctiveness in polymorphic whitefish, and evaluate taxonomic designations, we studied nine Norwegian lakes in three watercourses, which each harboured pairs of divergent whitefish morphs. We compared the morphology and life history of these morphs, documented the extent of genetic differentiation between them, and contrasted the niche use of sympatric morphs along both the habitat and resource axes. In all cases, sympatric morphs differed in the number of gill rakers, a highly heritable trait related to trophic utilization. Individual growth rate, age and size at maturity, diet and habitat use also differed between morphs within lakes, but were remarkably similar across lakes within the same morph. Microsatellite analyses confirmed for all but one pair that sympatric morphs were significantly genetically different, and that similar morphs from different lakes likely have a polyphyletic origin. These results are most compatible with the process of parallel evolution through recurrent postglacial divergence into pelagic and benthic niches in each of these lakes. We propose that sparsely and densely rakered whitefish sympatric pairs may be a likely case of ecological speciation, mediated in oligotrophic lakes with few trophic competitors.

Selective predation on parasitized prey--a comparison between two helminth species with different life-history strategies.

In Lake Fjellfrøsvatn, northern Norway, the larval helminths Cyathocephalus truncatus and Cystidicola farionis use Gammarus lacustris as intermediate hosts and Arctic charr (Salvelinus alpinus) as final hosts. There was sampled 1,433 live G. lacustris from the lake and 1,964 G. lacustris from stomach contents of the charr. Prevalence of infection were, respectively, 0.49% and 3.72% for C. truncatus, and 0.21% and 0.20% for C. farionis. Usually, only 1 parasite was present in each host, and the 2 parasite species never co-occurred. Gammarus lacustris amphipods parasitized by C. truncatus were positively selected by the Arctic charr and were consumed approximately 8 times as often as were the unparasitized amphipods or the amphipods infected with C. farionis. This suggests that G. lacustris amphipods infected with C. truncatus larvae are more susceptible to predation than noninfected specimens, probably because of parasite-induced alterations in behavior or visibility. Alternatively, this could also be explained by selection toward the largest G. lacustris specimens observed, which are also the most frequently parasitized amphipods. However, the data show clearly that this was not a result of size-selective predation by the charr. In contrast, the presence of C. farionis did not increase the susceptibility to predation of its intermediate host. The discrepancy between the 2 helminth species supports the hypothesis that parasite-increased susceptibility to predation is related to the life history strategies of the parasites.

Pharmacokinetics of rectal paracetamol after repeated dosing in children.

Twenty-three children (aged between 9 weeks and 11 yr) were given paracetamol suppositories 25 mg kg-1 every 6 h (maximum 5 days) after major surgery and serum and saliva concentrations were measured. There was a good correlation (r = 0.91, P < 0.05) between saliva and serum concentrations. A one-compartment linear model with first-order elimination and absorption and lag-time was fitted to the data (ADAPT II). At steady state, the mean (SD) concentration was 15.2 (6.8) mg litre-1. Mean (SD) time to reach 90% of the steady state concentration was 11.4 (8.6) h. Body weight, age and body surface area were well correlated (P < 0.05) with clearance and apparent volume of distribution. There was no evidence of accumulation leading to supratherapeutic concentrations during this dosing schedule for a mean of approximately 2-3 days.

Anaesthetic implications of rigid spine syndrome.

The perioperative management of a 14-year-old girl, suffering from the muscular disorder rigid spine syndrome, is presented. The anaesthetic implications with regard to possible difficult intubation, cardiac involvement, malignant hyperthermia, neuromuscular blocking agents, and postoperative recovery are discussed.

Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics.

This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n = 480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5-2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal (P = 0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in day patients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.

Patterns of coverage. Uniform versus graded density.

The goal of hair restoration surgery is undetectability. Anything that is unnatural or draws attention to itself is to be avoided. In extensive baldness (Norwood V1-V11) various patterns of coverage with grafting can be constructed. Principally they fall into either the graded or uniform density approaches. If the goal is to provide coverage of the entire area of extensive baldness, the uniform density approach offers the less noticeable result because it draws no attention to any particular part of the balding scalp. If the goal is to provide only frontal forelock reconstruction, both approaches are advocated. In less than ideal grooming situations such as in the wind, exercise, or swimming however, the uniform density approach appears to offer a less noticeable result.

[Continuous monitoring of end-tidal CO2-tension in non-intubated patients]. / Kontinuerlig monitorering af sluttidal CO2-tension hos ikkeintuberede patienter.

We describe and evaluate a method for continuously monitoring end-tidal CO2 (PETCO2) in non-intubated, spontaneously breathing patients. In 18 ASA I patients scheduled for minor surgery a 3.3 mm (10 CH) soft plastic catheter was preoperatively inserted through one nostril placing the tip at the level of the epiglottis. In the recovery room a capnograph was connected to the catheter for monitoring PETCO2. We found no significant differences between arterial carbon dioxide tension (PaCO2) and PETCO2 obtained by the catheter (0.2 +/- 2.2 mmHg) or obtained by a maximal expiration through a mouthpiece (-0.8 +/- 2.8 mmHg). We tested the possibility of mixing expired air with supplementary oxygen via the other nostril at a flowrate of 15 litres min-1, and found no significant difference in PETCO2 with or without flow (0.0 +/- 0.9 mmHg). Values are mean +/- SD. In conclusion we find that this method allows accurate monitoring of PETCO2 in non-intubated, spontaneously breathing patients even at supplementary oxygen flow-rates of up to 15 litres min-1.

[Time consumption at an orthopedic operating theatre. Physicians' ability to predict their own time consumption]. / Tidsforbrug på en ortopaedkirurgisk operationsstue. Loegers evne til at forudsige eget tidsforbrug.

The aim of the study was to investigate the time spent on different procedures in an orthopaedic operating theatre, and to evaluate the ability of doctors to predict their own time consumption. Time schedules were registered for 146 operations, of these 104 were either knee or hip replacements. Sixty percent of the total time was spent on surgery. The median misjudgment was 15 minutes for surgeons and five minutes for anaesthetists. An improvement in the doctors' ability to predict their own time consumption in the course of the study period could not be demonstrated. Comparing the study period with the similar period the year before it was not possible to demonstrate a change in the number of cancelled operations or the number of days with overtime. Epidural anaesthesia with bupivacaine was the most time consuming anaesthesia, the differences between the other forms of anaesthesia used were insignificant.

Effect of macrophage-specific colony-stimulating factor (CSF-1) on swine monocyte/macrophage susceptibility to in vitro infection by African swine fever virus.

Swine cells of the monocyte/macrophage lineage (MM) proliferate and survive for several weeks in vitro in medium supplemented with the murine macrophage-specific hematopoietic growth factor, colony-stimulating factor 1 (CSF-1). The extent to which MM, cultured in CSF-1, supported African swine fever virus (ASFV) growth in vitro was investigated. MM, cultured in medium with CSF-1, were sensitive to infection and viral-induced cytopathogenic damage by both natural field isolates of ASFV and fibroblast-adapted ASFV strains, as were primary MM (P-MM). Without CSF-1, blood mononuclear leukocytes (MNL), containing lymphocytes and MM, and P-MM could be reliably used in microculture for ASFV titration when inoculated at times limited to no more than 3 to 5 days after culture inception; inclusion of CSF-1 in the media stimulated continued MM survival and growth, and allowed for the use of MNL and P-MM for ASFV titration when inoculated as long as 2 to 3 weeks after microculture inception. MM that were propagated beyond 1 week in secondary culture in medium with CSF-1 (MM-CSF) were useful in microcultures for infective-ASFV titration, only when the cells were kept in medium with CSF-1 and inoculated no later than 3 days of culture inception. In vitro studies of ASFV infection in P-MM and in MM-CSF showed comparable kinetics in ASFV-induced hemadsorption (HAd), cytopathogenic effect (CPE), cytoplasmic viral antigens and nucleic acid material. Compared to P-MM in culture without CSF-1, relatively minor delays in CPE onset induced by some ASFV strains were noticed in MM-CSF and in P-MM that were placed in media with CSF-1. The effects of ASFV on DNA synthesis in the virus-susceptible MM, cultured with or without CSF-1, were also examined at different times of infection by measurement of 3H-thymidine (3H-TdR) incorporation into total precipitable culture material. ASFV-infection of P-MM, placed in culture medium with CSF-1, caused a pronounced transient increase in total 3H-TdR incorporation at the early onset of CPE and HAd. When compared to uninfected P-MM that were stimulated by CSF-1 to synthesize DNA, infected P-MM failed to incorporate 3H-TdR after CPE was fully evident. For P-MM that were cultured without CSF-1 and for MM-CSF, that were kept in culture with CSF-1, transient increases in 3H-TdR incorporation at the onset of CPE and HAd by ASFV-infection were evident, but were much less pronounced.

[Midazolam and ketamine for rectal premedication and induction of anesthesia in children]. / Midazolam und Ketamin zur rektalen Prämedikation und Narkoseeinleitung bei Kindern.

Fifteen healthy children 2-10 years old and scheduled for elective surgery, received midazolam 0.35 mg/kg body weight and atropine 0.025 mg/kg as rectal premedication about 35 min before the induction of anesthesia. The induction itself was carried out in a separate and quiet room next to the operating theatre by rectal administration of ketamine 10 mg/kg and midazolam 0.2 mg/kg. With the children breathing spontaneously, anesthesia was maintained by repetitive i.v. bolus injections of ketamine. The sedative and anticholinergic effects of the premedication were satisfactory. Induction of anesthesia was smooth. Consciousness was lost after 9-15 (mean 13) min. No significant adverse effects on hemodynamics or respiration were noted. Recovery from anesthesia was uneventful. No cases of rectal irritation or unpleasant dreams were reported. Post-operative analgesia was good. In conclusion, rectal administration of midazolam and atropine for premedication, followed by ketamine and midazolam for the induction of anesthesia, proved to be a pleasant, safe, and reliable method in pediatric anesthesia.

Lytic cocktail in children. Rectal versus intramuscular administration.

The efficacy of the lytic cocktail (1 ml contains pethidine 28 mg, promethazine 7 mg, chlorpromazine 7 mg) administered intramuscularly or rectally as premedication was studied in 51 children aged 1-12 years who had minor elective otological surgery. One group received 0.05 ml/kg intramuscularly (maximum dose 2.0 ml) and the other 0.07 ml/kg per rectum (maximum dose 2.8 ml). Most were satisfactorily sedated before operation, but after operation the rectally premedicated children were less sedated, which was in agreement with lower plasma pethidine concentrations in this group. The rectal dose should be increased if prolonged postoperative sedation is desireable.

In vitro induction of swine peripheral blood monocyte proliferation by the fibroblast-derived murine hematopoietic growth factor CSF-1.

The addition of conditioned medium from murine L929 fibroblasts (MGF) to cultures of swine peripheral blood mononuclear cells (MNL) resulted in growth of cells of macrophage/monocyte lineage (MO). Glass-adherent swine MNL, shown to be greater than 95% phagocytic MO, grew in the presence of MGF, whereas swine blood granulocytes and lymphocytes were not MGF-responsive. Primary and secondary MO growth were directly dependent on MGF presence and concentration. MGF-stimulated MO synthesized DNA, as measured by cellular incorporation of tritium-labeled thymidine (3H-TdR). This mitogenic response was maximal by 5 to 6 days in primary MO cultures and declined thereafter to a lower magnitude in secondary MO cultures. In the presence of MGF, viable MO numbers increased with an approximate population doubling time of 5 to 7 days in primary culture. This growth rate was prolonged, to about 10 to 12 days, for MGF-stimulated MO in secondary cultures. MGF removal from primary and secondary MO cultures resulted in rapid growth cessation and cell death. MGF-stimulated MO could not be sustained in secondary culture beyond 7 weeks. MGF-cultured MO were positive for latex phagocytosis, non-specific esterase, Fc-receptor expression, and could mediate antibody-dependent cell-mediated cytotoxicity. The MO-mitogenic principle of MGF was identified as the murine, macrophage-specific colony-stimulating factor, CSF-1 (M-CSF). The swine MO-proliferative response to MGF was inhibited by addition of monospecific goat antisera to M-CSF. Purified M-CSF stimulated the growth of swine MO from cultures of MNL and primary glass-adherent MO.

Evaluation of methods for chemically coupling foot-and-mouth disease virus to sheep red blood cells for immunological assays.

Six methods of chemically coupling proteins to red blood cells were evaluated for their effectiveness in coupling foot-and-mouth disease virus (FMDV) to sheep red blood cells. The coupling agents tested were potassium periodate, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (ECDI), chromium chloride, glutaraldehyde, bis-diazotized benzidine (BDB) and N-succinimidyl 3-(2-pyridyldithio) propionate (SPDP). Of these, only the coupling methods using BDB and SPDP resulted in virus-red cell complexes that reacted with FMDV antiserum in passive hemagglutination and passive immune hemolysis assays. The BDB and SPDP methods were studied further to determine optimal coupling conditions, the kinetics of coupling and the effects of chemical couplers on viral integrity. Only the FMDV-red cell complexes formed with SPDP were suitable targets for detecting FMDV antibody producing lymphocytes in a hemolytic plaque assay.

Cellular immunity to cytomegalovirus in a patient following bone marrow transplantation.

Cell-mediated immunity to cytomegalovirus (CMV) was studied in a bone marrow transplant patient with evidence of active CMV infection. The lymphocytes from this patient were found to specifically recognize and respond in vitro by transformation to CMV-infected Wistar-38 fibroblasts and by production of macrophage migration inhibition factor to CMV antigen. In addition, plasma and spinal fluid from the patient were found to contain blocking factor that specifically inhibited the lymphocyte response in the above assays. Biochemical, biophysical, and immunological studies indicate that the blocking factor may be an antigen-antibody complex.