MRI Findings in Acute Tonsillar Infections.

BACKGROUND AND PURPOSE: Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections. MATERIALS AND METHODS: We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards. RESULTS: The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness. CONCLUSIONS: Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.

Impact of deep learning-determined smoking status on mortality of cancer patients: never too late to quit.

BACKGROUND: Persistent smoking after cancer diagnosis is associated with increased overall mortality (OM) and cancer mortality (CM). According to the 2020 Surgeon General's report, smoking cessation may reduce CM but supporting evidence is not wide. Use of deep learning-based modeling that enables universal natural language processing of medical narratives to acquire population-based real-life smoking data may help overcome the challenge. We assessed the effect of smoking status and within-1-year smoking cessation on CM by an in-house adapted freely available language processing algorithm. MATERIALS AND METHODS: This cross-sectional real-world study included 29 823 patients diagnosed with cancer in 2009-2018 in Southwest Finland. The medical narrative, International Classification of Diseases-10th edition codes, histology, cancer treatment records, and death certificates were combined. Over 162 000 sentences describing tobacco smoking behavior were analyzed with ULMFiT and BERT algorithms. RESULTS: The language model classified the smoking status of 23 031 patients. Recent quitters had reduced CM [hazard ratio (HR) 0.80 (0.74-0.87)] and OM [HR 0.78 (0.72-0.84)] compared to persistent smokers. Compared to never smokers, persistent smokers had increased CM in head and neck, gastro-esophageal, pancreatic, lung, prostate, and breast cancer and Hodgkin's lymphoma, irrespective of age, comorbidities, performance status, or presence of metastatic disease. Increased CM was also observed in smokers with colorectal cancer, men with melanoma or bladder cancer, and lymphoid and myeloid leukemia, but no longer independently of the abovementioned covariates. Specificity and sensitivity were 96%/96%, 98%/68%, and 88%/99% for never, former, and current smokers, respectively, being essentially the same with both models. CONCLUSIONS: Deep learning can be used to classify large amounts of smoking data from the medical narrative with good accuracy. The results highlight the detrimental effects of persistent smoking in oncologic patients and emphasize that smoking cessation should always be an essential element of patient counseling.

Radiographic Outcomes of Immobilization using Boston Brace for Pediatric Spondylolysis.

BACKGROUND AND AIMS: Spondylolysis is a common cause of lower back pain during youth. The aim of this study is to report the bony union rate and risk factors for non-union of the lumbar spondylolysis of pediatric patients treated with a rigid thoracolumbosacral orthosis (Boston brace). MATERIALS AND METHODS: A retrospective review of 68 children (mean age = 13.9 years) treated for spondylolysis with a thoracolumbosacral orthosis. Patient charts and imaging studies were evaluated to identify the bony union rate of the spondylolysis after a minimum of 3 months of immobilization (mean = 4.2 months). Laterality, grade, level, and presence of high signal intensity in the magnetic resonance imaging were evaluated as prognostic factors. RESULTS: Sixty-eight patients presented with 110 defects. Of them, 46 (42%) were incomplete fractures, 38 (35%) complete fractures, and 26 (24%) pseudoarthrosis. Of these defects, 38 (82.6%), 11 (28.9%), and 0 (0.0%) had bony union at the end of the treatment (p < 0.001). Unilateral defects healed significantly better than bilateral ones (relative risk = 1.71, 95% confidence interval = 1.16-2.54, 17/26 (65%) vs 32/84 (38%), p = 0.014). High signal intensity in the magnetic resonance images before the treatment predicted healing (relative risk = 13.24, 95% confidence interval = 1.93-91.01, 48/87 (55%) vs 1/24 (4.3%), p < 0.001). The level of the spondylolysis (L5 vs above L5) did not affect the healing rate. CONCLUSION: The union rates of spondylolysis with a thoracolumbosacral orthosis were similar as compared to earlier studies done with a low thoracolumbosacral orthosis. The grade of the defect, laterality, and presence of high signal intensity increased the probability of bony union. A high thoracolumbosacral orthosis (underarm) does not seem to improve the healing rate of pediatric spondylolysis defects.

Continuity of care is associated with satisfaction with local health care services.

BACKGROUND: Satisfaction is a major element in assessing quality of care. It has decreased in Finland in recent decades as well as continuity of care. We investigated which demographic, health-related, and local health care service factors, especially continuity of care, are associated with the population's satisfaction with local health care services. METHODS: The data are part of the Health and Social Support (HeSSup) study's follow-up questionnaire in 2012. The study is based on a random Finnish population sample. Satisfaction was studied based on the question "How satisfied are you with your local health care services?" Demographic factors, obesity, self-assessed health status, depressive mood (BDI-12 questionnaire), New York Heart Association class, and chronic diseases were asked in the questionnaire. Questions describing local health care services were also presented. We assessed the association of an assigned and named GP and the respondents' proactivity in contacting the same doctor with satisfaction. We used crosstabulation and binary logistic regression in the analyses. RESULTS: The Health and Social Support study was answered in 2012 by 15,993 participants (45.4%) and majority (61.3%) was satisfied with their local health care services. An assigned and named GP (OR 1.79; 95% CI 1.67-1.92) and the respondent's proactivity in contacting the same doctor (OR 1.23; 95% CI 1.15-1.32) were associated with satisfaction in the adjusted multivariate analysis. BDI score < 19 had the strongest association with satisfaction (OR 1.91; 95% CI 1.65-2.23). Older participants, males, and those in a relationship were more likely to be satisfied. CONCLUSIONS: A named GP in primary care proved to have a positive correlation with patient satisfaction. Depression was associated with decreased satisfaction. A named GP indicates continuity of care, and it should be seriously considered when planning treatment for patients with chronic conditions.

Fluid flow simulations meet high-speed video: Computer vision comparison of droplet dynamics.

HYPOTHESIS: While multiphase flows, particularly droplet dynamics, are ordinary in nature as well as in industrial processes, their mathematical and computational modelling continue to pose challenging research tasks - patent approaches for tackling them are yet to be found. The lack of analytical flow field solutions for non-trivial droplet dynamics hinders validation of computer simulations and, hence, their application in research problems. High-speed videos and computer vision algorithms can provide a viable approach to validate simulations directly against experiments. EXPERIMENTS: Droplets of water (or glycerol-water mixtures) impacting on both hydrophobic and superhydrophobic surfaces were imaged with a high-speed camera. The corresponding configurations were simulated using a lattice-Boltzmann multiphase scheme. Video frames from experiments and simulations were compared, by means of computer vision, over entire droplet impact events. FINDINGS: The proposed experimental validation procedure provides a detailed, dynamic one-on-one comparison of a droplet impact. The procedure relies on high-speed video recording of the experiments, computer vision, and on a software package for the analyzation routines. The procedure is able to quantitatively validate computer simulations against experiments and it is widely applicable to multiphase flow systems in general.

Painful musculosceletal disorders and depression among working aged migraineurs.

OBJECTIVE: Musculoskeletal disorders and depression are common among migraineurs. The aim of our study was to evaluate the occurrence of these disorders among working aged migraineurs. MATERIAL AND METHODS: The risk for fibromyalgia, rheumatoid arthritis (RA), osteoarthrosis (OA), sciatic syndrome, and the occurrence of depression was studied among cases who reported about these conditions and migraine in working aged Finnish population in The Health and Social Support Study (HeSSup) based on postal questionnaire in 2012. Group differences were tested by chi-square test. Odds ratios (ORs with 95% CI) adjusted for age, gender, education level and depression were calculated with logistic regression analysis. RESULTS: Total of 1505 migraineurs (13%) and 8092 controls were included among the 11 596 responders in 2012. Age and gender adjusted ORs, 2.37 (95% CI 1.81-3.09) for fibromyalgia, 1.46 (1.10-1.95) for RA, 1.58 (1.38-1.80) for OA, and 2.09 (1.84-2.37) for sciatic syndrome, were significant. At least moderate depression was more common among migraineurs (7.3%) than among controls (3.4%) (P < .001). CONCLUSION: Recognition of comorbid musculoskeletal disorders and mood disorders among migraineurs needs targeted outreach in working aged population. The acute and preventive treatments to control for neuronal sensitization in migraine and comorbid pain disorders may benefit of individual treatment plan and tailored use of antidepressants.

Feasibility of Day Surgery in Patients With Breast Conservation and Sentinel Node Biopsy: A Randomized Controlled Trial.

BACKGROUND AND AIMS: The aim of this study was to analyze feasibility of day surgery in breast cancer patients with breast conserving surgery and sentinel node biopsy. MATERIAL AND METHODS: The study was a randomized controlled trial comparing day surgery with one night hospital stay in breast cancer patients with breast conserving surgery and sentinel node biopsy. A total of 40 patients with ⩽3-cm tumor and clinically N0 were randomized to one night stay group and 38 patients to day surgery group. Within discharge, patients and their relatives were given questionnaires in order to evaluate their experience regarding the duration of hospital stay. RESULTS: Randomized groups were similar regarding patient age and tumor stage. A total of 18 (47%) day surgery group patients were discharged the same day. The most common reason for overnight hospital stay was axillary clearance, 9 (24%). None of the patients in the day surgery group, but 2 patients in the overnight hospital stay group had re-operation due to complications. Perception and preference results were analyzed both according to randomization and actual treatment groups. Patients in both groups had rather similar experiences on the first postoperative day. Also, spouse's or relative's perception after discharge was similar in both groups. CONCLUSION: Day surgery was well received by the patients and their relatives. Day surgery appears as feasible in patients with breast conservation and sentinel node biopsy.

Reduction mammaplasty as an outpatient procedure: a retrospective analysis of outcome and success rate.

BACKGROUND AND AIMS: Reduction mammaplasty is an increasingly common plastic surgical procedure. In the United States, majority of breast reductions are performed as outpatient surgery. In European public health care, outpatient breast reductions have still been rare. Our aim was to retrospectively determine clinical outcome and the success rate of outpatient reduction mammaplasty. MATERIAL AND METHODS: A total of 110 consecutive patients underwent bilateral reduction mammaplasty with a minimum resection of 200 g per breast in an outpatient unit between 2006 and 2009. A comparison group consisted of 28 inpatients. Demographic data and pre-, intra-, and postoperative events as well as complications were recorded. RESULTS: A total of 83 outpatients (75%) were successfully discharged on the day of operation. Reasons for unexpected overnight admission were lack of adult company for the first postoperative night (13 patients, 12%), surgeon's wish (4 patients, 4%), hematoma requiring evacuation (5 patients, 5%), nausea (3 patients, 3%), and pain (2 patients, 2%). Minor complications, especially delayed healing, were common (45 patients, 41%), but major complications were rare (18 patients, 16%). Complication rate was not increased in the outpatient group. Increased duration of operation correlated with increasing complications. CONCLUSION: Reduction mammaplasty can be successfully and safely performed as an outpatient procedure in European public health care.

Consistent lattice Boltzmann equations for phase transitions.

Unlike conventional computational fluid dynamics methods, the lattice Boltzmann method (LBM) describes the dynamic behavior of fluids in a mesoscopic scale based on discrete forms of kinetic equations. In this scale, complex macroscopic phenomena like the formation and collapse of interfaces can be naturally described as related to source terms incorporated into the kinetic equations. In this context, a novel athermal lattice Boltzmann scheme for the simulation of phase transition is proposed. The continuous kinetic model obtained from the Liouville equation using the mean-field interaction force approach is shown to be consistent with diffuse interface model using the Helmholtz free energy. Density profiles, interface thickness, and surface tension are analytically derived for a plane liquid-vapor interface. A discrete form of the kinetic equation is then obtained by applying the quadrature method based on prescribed abscissas together with a third-order scheme for the discretization of the streaming or advection term in the Boltzmann equation. Spatial derivatives in the source terms are approximated with high-order schemes. The numerical validation of the method is performed by measuring the speed of sound as well as by retrieving the coexistence curve and the interface density profiles. The appearance of spurious currents near the interface is investigated. The simulations are performed with the equations of state of Van der Waals, Redlich-Kwong, Redlich-Kwong-Soave, Peng-Robinson, and Carnahan-Starling.

Psoriasis causes significant economic burden to patients.

INTRODUCTION: Psoriasis results in expenses to patients from many cost sources. Psoriasis treatments may result in considerable time and traveling costs, yet many studies fail to account for these costs. The objective of this study was to evaluate the multidimensional economic burden of psoriasis to patients. METHODS: The study was based on 232 Finnish patients with psoriasis or psoriatic arthritis visiting a tertiary level dermatological clinic during a 1-year study period between October 1, 2009 and September 30, 2010. The data were based on a patient questionnaire, clinical data from the medical records and reimbursement data from the Finnish Social Insurance Institution. Item costs were based on true costs charged from the patients and all time cost estimates were based on the Human Capital Approach method. RESULTS: 199 patients with psoriasis and 33 with psoriatic arthritis were included in the study. Total costs were higher for patients receiving traditional systemic medications or phototherapy than those not receiving such treatment. Travel costs and travel time costs accounted for more than 60% of the costs of phototherapy. Skin care at home was time consuming and thus caused significant burden to patients. The majority of the visit costs arose from hospital visits and only a small proportion were attributed to visiting primary health care providers. CONCLUSION: Visit charges and other patient co-payments were estimated to play a minor role in the total cost of psoriasis incurred by patients, while travel costs and lost time comprised the majority of the costs, which should not be omitted in future studies regarding costs of treatments.

Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results.

We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age. A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and physiotherapy (group 2) and rotator cuff repair, acromioplasty and physiotherapy (group 3). The Constant score was assessed and followed up by an independent observer pre-operatively and at three, six and twelve months after the intervention. Of these, 167 shoulders were available for assessment at one year (follow-up rate of 92.8%). There were 55 shoulders in group 1 (24 in males and 31 in females, mean age 65 years (55 to 79)), 57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female, mean age 65 years (55 to 81)). There were no between-group differences in the Constant score at final follow-up: 74.1 (sd 14.2), 77.2 (sd 13.0) and 77.9 (sd 12.1) in groups 1, 2 and 3, respectively (p = 0.34). The mean change in the Constant score was 17.0, 17.5, and 19.8, respectively (p = 0.34). These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.

Quality of life change in elderly patients undergoing open inguinal hernia repair.

PURPOSE: A growing proportion of inguinal hernia patients are at least 65 years old. Assessing operational benefits versus risks in this group of elderly patients merits research. METHODS: Patients in two prospective trials (1:n = 134, 89 elderly; 2:n = 398, 70 elderly) completed RAND-36 questionnaires preoperatively (response rate 100 and 98.5 %, respectively) and at 3 (98.5 %) or 12 months (89.6 %) after open inguinal hernia repair. In both groups, preoperative and postoperative quality of life data were statistically compared within age categories. Quality of life change was compared between age categories. Immediate complications were recorded. RESULTS: The dimensions physical functioning and pain improved significantly in the elderly and under 65-year-olds. Role functioning/physical and social functioning showed improvement as well, but less constantly. No statistical difference in complication rates was found across age groups. CONCLUSION: Inguinal hernia surgery improves physical and social dimensions of quality of life among elderly and under 65-year-olds similarly.

Medial malleolar stress fracture in athletes: diagnosis and operative treatment.

BACKGROUND AND AIMS: Stress fractures are common overuse injuries in athletes. Medial malleolar stress fractures are rare but they have an important clinical relevance because of their tendency to cause considerable disability and loss of time in sports without proper treatment. The diagnosis of medial malleolar stress fracture is often a challenge and it is therefore often delayed which may cause even further problems in the treatment. The purpose of this study was to increase the awareness of medial malleolar stress fractures as a possible cause for medial ankle pain and to stress the importance of MRI in the diagnostics as well as to evaluate the results of surgical treatment. PATIENTS AND METHODS: Between 1995 and 2008, a total of ten athletes with a medial malleolar stress fracture were operated at our centre. All operated cases during those years were included in the study. The cases were retrospectively analyzed. Return to pre-injury level of sport was evaluated and considered as an indicator of successful treatment. RESULTS: Initially all standard radiographs were negative whereas in MRI the fractures were all visible. After operative treatment all medial malleolar stress fractures healed clinically in three to four months and all except one of the athletes were able to return to their pre-injury level of sports. CONCLUSION: Early MRI is recommended if a medial malleolar stress fracture is suspected. Surgical treatment seems to result in rapid healing of the fracture and return to sports. In our opinion early surgery should be considered especially in athletes.

Bioactive glass S53P4 and autograft bone in treatment of depressed tibial plateau fractures - a prospective randomized 11-year follow-up.

The clinical and radiological outcomes of bioactive glass (BAG)-S53P4 and autograft bone (AB) used as bone-graft substitutes in depressed tibial plateau fractures were evaluated in a prospective randomized 11-year follow-up study. All patients (n = 29) had sustained tibial plateau fractures with a joint-line depression of >3 mm. Fifteen patients (5 patients the BAG group, 10 patients in the AB group) participated in this long-term follow-up. X-rays were taken preoperatively, postoperatively, and at the long-term follow-up, and computed tomography (CT) scans were made at the long-term follow-up for evaluation of the bone substitute, osteoarthritis, the tibial-femoral angle, and deviation of mechanical axes. No material-dependent adverse effects were seen in any patient. The means of the articular surface depression on X-rays at the long-term follow-up were 1.4 mm (range: 0-2 mm) in the BAG group and 1.4 mm (range: 0-4 mm) in the AB group, and on CT scans the means were 2.2 mm (range: 2-3 mm), and 2.1 mm (range: 0-3), respectively. No significant difference in the tibial-femoral angle or deviation of mechanical axes was observed between the two groups. BAG-S53P4 can be used as a bone substitute in depressed lateral tibial plateau fractures with good functional and radiological long-term results.

Cold temperature decreases bacterial species richness in nitrogen-removing bioreactors treating inorganic mine waters.

Explosives used in mining, such as ammonium nitrate fuel oil (ANFO), can cause eutrophication of the surrounding environment by leakage of ammonium and nitrate from undetonated material that is not properly treated. Cold temperatures in mines affect nitrogen removal from water when such nutrients are treated with bioreactors in situ. In this study we identified bacteria in the bioreactors and studied the effect of temperature on the bacterial community. The bioreactors consisted of sequential nitrification and denitrification units running at either 5 or 10°C. One nitrification bioreactor running at 5°C was fed with salt spiked water. From the nitrification bioreactors, sequences from both ammonia- and nitrite-oxidizing bacteria were identified, but the species were distinct at different temperatures. The main nitrifiers in the lower temperature were closely related to the genera Nitrosospira and Candidatus Nitrotoga. 16S rRNA gene sequences closely related to halotolerant Nitrosomonas eutropha were found only from the salt spiked nitrification bioreactor. At 10°C the genera Nitrosomonas and Nitrospira were the abundant nitrifiers. The results showed that bacterial species richness estimates were low, <150 operational taxonomic units (OTUs), in all bioreactor clone libraries, when sequences were assigned to operational taxonomic units at an evolutionary distance of 0.03. The only exception was the nitrification bioreactor running at 10°C where species richness was higher, >300 OTUs. Species richness was lower in bioreactors running at 5°C compared to those operating at 10°C.

Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgery.

BACKGROUND: Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. METHODS: Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented. RESULTS: Twenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0-165) mg in the dexamethasone group and 78 (15-175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0-1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0-1, and significantly less nausea on POD 1. On PODs 2-3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ - in both groups 81% would have chosen the same medication again. CONCLUSION: Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus.

Modelling of Bet v 1 binding to lipids.

As birch pollen allergen enters epithelium of allergic patients via lipid rafts and caveola we began to analyse its putative amphiphilic and lipid ligands on atomic level using molecular modelling and computational ligand docking. We carry out 3D modelling docking with both experimentally verified Bet v 1 ligands as well as larger lipid molecules for which experimental affinity studies were not available. The results suggest that the hydrophobic cavity of Bet v 1 has different binding sites for different ligands and groups of ligand type-specific amino acids can be defined. Bet v 1 proteins may also be able to bind and transport more complex amphiphilic molecules like ceramides and sphingomyelins known to be enriched on caveolae/lipid rafts. Furthermore, the suggested binding mode, where the hydrophobic tail groups of lipids locate inside Bet v 1, while the polar head group may remain solvent accessible, would allow Bet v 1 to bind glycolipids, e.g. gangliosides, also rich on caveolae/lipid rafts. Taken together, this in silico work suggests that Bet v 1 bind to amphiphilic and lipid ligands present on the caveolae/lipid rafts and thus could provide a molecular mechanism for the pollen entry to epithelial tissue of allergic patients.

Day surgery in Finland: a prospective cohort study of 14 day-surgery units.

BACKGROUND: Day surgery is an established practice for elective operative care, and is considered safe and cost-effective in several procedures and for several patients. At present, day-surgery accounts for approximately 50% of elective surgery in Finland. The aim of this study was to prospectively describe the present situation at Finnish day-surgery units, focusing on the quality of care. METHODS: Fourteen large- to medium-sized day surgery and short-stay units were recruited, and all patient cases performed during a 2-month study period were registered and analyzed. Quality of care was assessed by analyzing the rates and reasons for overnight admission, readmission, reoperation, and cancellations. Satisfaction of care was inquired from day-surgery patients during a 2-week period. Head anesthesiologists were interviewed about functional policies. RESULTS: Of 7915 reported cases, 84% were day surgery. Typically, several specialties were represented at the units, with orthopedics accounting for nearly 30% of all day-surgery procedures. Patient selection criteria were in line with the present-day recommendations, although the proportion of older patients and the ASA physical status 3 patients were still relatively low. The rate of unplanned overnight admissions was 5.9%. Return hospital visits were reported in 3.7% and readmissions in 0.7% of patients 1-28 days post-operatively. Patient satisfaction was high. CONCLUSION: Along with the growing demand for day surgery, Finnish public hospitals have succeeded in providing good-quality care, and there still seems to be potential to increase the share of day surgery. Easily accessible benchmarking tools are needed for quality control and learning from peers.

Patellar tendon shortening after treatment of patellar instability with a patellar tendon medialization procedure.

Patellar instability is a multifactorial disorder. Patella alta is strongly associated with patellar instability. We hypothesize that procedures of the patellar tendon such as medialization may shorten the patellar tendon. In this retrospective study, 41 patients with patellar instability were treated operatively with a patellar tendon medialization procedure. Twenty-eight knees were treated using a modified Roux-Goldthwait method and 16 using a modified Elmslie-Trillat method. The patients were followed 2-7 years after the operation. Pre- and post-operative x-rays were analyzed with particular emphasis on patellar tendon length, patellofemoral congruence angle and osteoarthritis. The final clinical outcome was assessed using the Lysholm score and clinical examination. In both groups patients were generally satisfied with the result of the operation and there was no significant difference in Lysholm scores at follow-up. However, patellofemoral osteoarthritic changes increased in both groups compared with the pre-operative status. The patellar tendon length was reduced in both groups, but significantly, by 7%, in the Roux-Goldthwait group. We conclude that patellar tendon shortens after a Roux-Goldthwait procedure.

High plasma levels of CD40 are associated with low coenzyme Q and vitamin E content of low-density lipoprotein in healthy men.

OBJECTIVE: There is a growing body of evidence to suggest that low-density lipoprotein (LDL) cholesterol, inflammation and oxidative stress are pivotal in the development of cardiovascular disease, but their interconnections are not well known. The objective of this study was to determine whether immunological activation, reflected by the plasma levels of soluble CD40 (sCD40), interleukin (IL)-1beta, tumor necrosis factor-alpha and IL-6 are associated with the antioxidant potential of LDL particles or with common lipid, immunological or thrombotic markers in 51 young healthy men. MATERIAL AND METHODS: We determined the coenzyme Q level from an oxidized LDL fraction, obtaining the concentration for ubiquinone, which indicates total coenzyme Q levels. RESULTS: The plasma level of sCD40 was negatively correlated with LDL ubiquinone (r=-0.45, p=0.001) and E vitamin (r=-0.37, p=0.008) and positively correlated with plasma concentration of plasminogen activator inhibitor-1 (PAI-1, r=0.52, p=0.002) and caspase-1 (r=0.40, p=0.004). No correlation was detected between sCD40 and plasma lipid or C-reactive protein concentrations. As sCD40 was strongly correlated with the content of LDL ubiquinone and vitamin E, their values were compared according to groups formed by sCD40 tertiles. Analysis of variance showed that there were significant differences in LDL ubiquinone (p<0.0001) and vitamin E (p=0.004) concentrations between sCD40 tertiles. CONCLUSIONS: The data indicate that increased activation of the CD40 system is related to low levels of LDL ubiquinone and vitamin E. This suggests that chronic or increased immunological activation may consume the antioxidant potential of LDL particles.