The alarmins high mobility group box protein 1 and S100A8/A9 display different inflammatory profiles after acute knee injury

OBJECTIVE

To compare the concentrations of high mobility group box 1 protein (HMGB1) and S100A8/A9 in synovial fluid between patients with knee injuries and osteoarthritis (OA), and knee healthy subjects. To investigate associations of alarmin levels with different joint injuries and with biomarkers of inflammation, Wnt signaling, complement system, bone and cartilage degradation.

METHODS

HMGB1 and S100A8/A9 were measured in synovial fluid by immunoassays in patients with knee injuries, with OA and from knee healthy subjects, and were related to time from injury and with biomarkers obtained from previous studies. Hierarchical cluster and enrichment analyses of biomarkers associated to HMGB1 and S100A8/A9 were performed.

RESULTS

The synovial fluid HMGB1 and S100A8/A9 concentrations were increased early after knee injury; S100A8/A9 levels were negatively associated to time after injury and was lower in the old compared to recent injury group, while HMGB1 was not associated to time after injury. The S100A8/A9 levels were also increased in OA. The initial inflammatory response was similar between the alarmins, and HMGB1 and S100A8/A9 shared 9 out of 20 enriched pathways. The alarmins displayed distinct response profiles, HMGB1 being associated to cartilage biomarkers while S100A8/A9 was associated to proinflammatory cytokines.

CONCLUSIONS

HMGB1 and S100A8/A9 are increased as an immediate response to knee trauma. While they share many features in inflammatory and immunoregulatory mechanisms, S100A8/A9 and HMGB1 are associated to different downstream responses, which may have impact on the OA progression after acute knee injuries.

FRI0411 SAFETY, TOLERABILITY, PHARMACOKINETICS AND PHARMACODYNAMICS IN HEALTHY MALE JAPANESE SUBJECTS OF THE ADAMTS-5 INHIBITOR S201086/GLPG1972, A POTENTIAL NEW TREATMENT IN OA

Background:

The disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5) is a key enzyme in OA (Verma P,et al.J Cell Biochem 2011;112:3507-14). In preclinical models of OA, S201086, a potent and selective ADAMTS-5 inhibitor, protects from cartilage degradation (Clement-Lacroix,et al.Osteoarthritis Cartilage 2017;25:S58). Therefore, S201086 is co-developed by Servier and Galapagos (GLPG1972) as a potential new treatment in OA.

Objectives:

This phase I study was to assess and compare the safety, tolerability, pharmacokinetics and pharmacodynamics of S201086 in healthy male Japanese and Caucasian subjects.

Methods:

Six ascending single doses of S201086 (50 to 1500 mg) were administered orally as tablets in fasting conditions in 6 groups of 8 Japanese subjects (aged 20-45 years) and 3 ascending multiple doses (300, 600 or 1050 mg/day for 14 days) were administered orally as tablets in fed conditions in 3 groups of 8 Japanese subjects. Additionally, 2 cohorts of 8 Caucasian subjects received either a single oral dose of 300 mg or repeated oral dose of 300 mg once daily for 14 days. In each group, 6 subjects received S201086 and 2 placebo. Plasma was collected at several time points for the quantification of S201086 by LC-MS/MS. Plasma pharmacokinetic parameters were calculated via non-compartmental analysis using Phoenix® WinNonlin® software. Pharmacodynamics was assessed by measurement of the aggrecan ARGS neoepitope levels in serum by ELISA.

Results:

No serious adverse drug reactions were observed after administration of single and multiple ascending doses of S201086 in either Japanese or Caucasian subjects. Most adverse events were of mild to moderate intensity and were resolved by the end of the study. Following single administration to Japanese subjects, Cmax and AUC increased proportionally with doses from 50 to 600 mg and slightly less than dose-proportionally from 600 to 1500 mg, consistent with what was previously observed in the first in-human study in healthy Caucasian subjects (van der Aar E,et al.Osteoarthritis Cartilage 2018;26:S310). In Japanese subjects, after 14-days administration, a limited 1.2- to 1.4-fold accumulation was observed on both Cmax and AUC at Day14 as compared to Day1, and the steady-state exposure increased dose-proportionally within the 300-1050 mg dose range. Taking the inter-subject variability into account, no difference was observed in Cmax and AUC between Caucasian and Japanese subjects after single administrations of 300 mg and repeated administrations of 300 mg once daily for 14 days. The serum ARGS neoepitope levels decreased between baseline and last day of treatment for S201086-treated subjects but not for subjects receiving placebo. This decrease was similar for the 3 tested doses in Japanese subjects and was significant as compared to the placebo-treated subjects.

Table.

Comparison of ARGS concentration relative change from baseline to last day of treatment according to dose in Japanese participants

S 201086 300 mg (N = 6)S 201086 600 mg (N = 6)S 201086 1050 mg (N = 6)Placebo (N = 6)Descriptive Statistics(D14 pre-dose – Baseline) / Baselinen6646Mean ± SD-42.67 ± 8.81-53.70 ± 6.50-54.11 ± 5.2013.35 ± 16.53Statistical analysisE (SE)56.01 (6.156)67.04 (6.156)67.45 (6.883)95% CI43.08; 68.9554.11; 79.9752.99; 81.91p-value< 0.0001< 0.0001< 0.0001

Conclusion:

S201086 was shown to be safe and well-tolerated in Japanese and Caucasian healthy male subjects with a suitable PK profile and a significant decrease of the ARGS neoepitope, indicating target engagement. A global Phase 2 study to evaluate the efficacy of S201086 in patients with knee OA is ongoing (NCT03595618).

Disclosure of Interests:

Agnès Lalande Employee of: Institut de Recherches Internationales Servier, Nadya KUZNIATSOVA-MOUCHETTE Employee of: Institut de Recherches Internationales Servier, Florian CHASSEREAU Employee of: Institut de Recherches Internationales Servier, Julia GERONIMI Employee of: Institut de Recherches Internationales Servier, Katy Bernard Employee of: Institut de Recherches Internationales Servier, Staffan Larsson: None declared, André Struglics: None declared, Stefan Lohmander: None declared, Maria Pueyo Employee of: Institut de Recherches Internationales Servier

Molecular and imaging biomarkers of local inflammation at 2 years after anterior cruciate ligament injury do not associate with patient reported outcomes at 5 years

OBJECTIVE

To estimate the association between molecular or imaging inflammatory biomarkers at 2 years after anterior cruciate ligament (ACL) injury and patient-reported outcomes at 5 years.

METHODS

For 116 ACL-injured patients, molecular biomarkers of inflammation (synovial fluid and serum cytokines) and Hoffa- and effusion-synovitis as visualized on magnetic resonance imaging (MRI) were assessed 2 years post-injury. Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were assessed at 2 and 5 years. We used multiple imputation to handle biomarker values that were below the level of detection or missing, and linear regression for statistical analyses.

RESULTS

None of the synovial fluid cytokines or imaging biomarkers of inflammation at 2 years were associated with any of the patient-reported outcomes at 5 years. With each log10 unit higher of serum tumor necrosis factor concentration the knee-related quality of life of KOOS was increased (i.e., better outcome) by 35 (95% confidence interval 7 to 63) points. No other serum biomarker measured at 2 years was associated with patient-reported outcome at 5 years.

CONCLUSION

Local joint inflammation assessed by biomarkers in synovial fluid and Hoffa- and effusion-synovitis on MRI at 2 years after an ACL injury did not associate with patient-reported outcomes at 5 years. Thus, chronic inflammation in the ACL-injured knee, as reflected by the biomarkers studied here, seems not to be a key determinant for the long-term patient-reported outcomes.

Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery

BACKGROUND AND AIMS

Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures.

PATIENTS AND METHODS

Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models.

RESULTS

There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited.

CONCLUSION

Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.

Unresolved Gamma-Ray Sky through its Angular Power Spectrum

The gamma-ray sky has been observed with unprecedented accuracy in the last decade by the Fermi -large area telescope (LAT), allowing us to resolve and understand the high-energy Universe. The nature of the remaining unresolved emission [unresolved gamma-ray background (UGRB)] below the LAT source detection threshold can be uncovered by characterizing the amplitude and angular scale of the UGRB fluctuation field. This Letter presents a measurement of the UGRB autocorrelation angular power spectrum based on eight years of Fermi-LAT Pass 8 data products. The analysis is designed to be robust against contamination from resolved sources and noise systematics. The sensitivity to subthreshold sources is greatly enhanced with respect to previous measurements. We find evidence (with ∼3.7σ significance) that the scenario in which two classes of sources contribute to the UGRB signal is favored over a single class. A double power law with exponential cutoff can explain the anisotropy energy spectrum well, with photon indices of the two populations being 2.55±0.23 and 1.86±0.15.

How do macro-level structural determinants affect inequalities in mental health? - a systematic review of the literature

BACKGROUND

In Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes.

METHODS

We conducted a systematic review of quantitative studies published between 1996 and 2017 based on search results from the following databases Medline, Embase, PsychInfo, Web of Science, Sociological Abstracts and Eric. Studies were included if they focused on inequalities (measured by socio-economic position and gender), structural determinants (i.e. public policies affecting the whole population) and showed a change or comparison in mental health status in one (or more) of the Organisation for Economic Cooperation and Development (OECD) countries. All studies were assessed for inclusion and study quality by two independent reviewers. Data were extracted and synthesised using narrative analysis.

RESULTS

Twenty-one articles (17 studies) met the inclusion criteria. Studies were heterogeneous with regards to methodology, mental health outcomes and policy settings. More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied.

CONCLUSION

Although the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities.

Changes in synovial fluid and serum concentrations of cartilage oligomeric matrix protein over 5 years after anterior cruciate ligament rupture: an exploratory analysis in the KANON trial

OBJECTIVE

To monitor longitudinal changes of cartilage oligomeric matrix protein (COMP) in synovial fluid (sf) and serum (s) over 5 years after acute anterior cruciate ligament (ACL) rupture, and to compare results from two commercial COMP immunoassays.

DESIGN

Bio-fluids were collected from 121 patients on six occasions over 5 years after acute ACL injury, and from 25 knee healthy reference subjects. Concentrations of sf- and sCOMP were measured by AnaMar (sCOMP-Ana) and by BioVendor (sf- and sCOMP-Bio) immunoassays; other biomarkers were previously assessed. We used ANCOVA for group comparisons and linear mixed models for associations between biomarkers over 5-years with P < 0.05 considered a statistically significant difference or association.

RESULTS

Compared to the reference group, sfCOMP-Bio concentrations were 2-fold elevated within 6 weeks after ACL injury and remained elevated 5 years thereafter, whereas sCOMP-Bio and sCOMP-Ana concentrations were no different from reference levels at any time point. Over the 5-year period, there was an association between sCOMP-Bio and sCOMP-Ana concentrations, although neither sCOMP-Bio nor sCOMP-Ana associated with sfCOMP-Bio. sfCOMP-Bio associated with SF ARGS-aggrecan, urine type I and II collagens (uNTX-I and uCTX-II) and SF cytokines, while sCOMP-Bio associated inversely with uCTX-II, uNTX-I and SF cytokines.

CONCLUSION

The local process after an acute ACL injury generates increased SF COMP concentrations in the injured knee up to 5 years after injury. This response is not detected in serum. Discrepancies in associations between sCOMP measured by BioVendor and AnaMar immunoassays with other biomarkers indicate differences in detected COMP fragments.

Dickkopf-related protein 1 and gremlin 1 show different response than frizzled-related protein in human synovial fluid following knee injury and in patients with osteoarthritis

OBJECTIVE

To explore the involvement of the wingless-type MMTV integration site (WNT) and bone morphogenetic protein (BMP) antagonists dickkopf-related protein 1 (DKK1), frizzled-related protein (FRZB) and gremlin 1 (GREM1) in knee injury and osteoarthritis (OA).

DESIGN

The antagonists were immunoassayed in synovial fluid from a cross-sectional cohort of nine knee healthy reference subjects, patients with recent (0-77 days, n = 158) or old (1-37 years, n = 50) knee injuries, and OA (n = 22). Cartilage (ARGS-aggrecan, cartilage oligomeric matrix protein and C2C type II collagen) and other biomarkers were assessed in synovial fluid in a subset of samples. Statistical analysis was by Kendall's tau (τ) correlation, Mann-Whitney U test, and linear regression analysis.

RESULTS

Compared to references, median concentration of GREM1 (but not DKK1 and FRZB) was elevated 1.5-fold immediately after injury, and FRZB was reduced 1000-folds in OA. All three antagonists decreased with increasing time after injury as well as with increasing age, but the temporal change after injury was less accentuated for FRZB (peaked 8-22 days after injury) compared to that of DKK1 and GREM1 (peaked immediately after injury). In the recent injury group, there was a correlation between GREM1 and DKK1 (τ = 0.172); FRZB concentrations correlated with concentrations of cartilage biomarkers (τ between 0.257 and 0.369), while DKK1 and GREM1 were inversely correlated (τ between -0.177 and -0.217) with these markers.

CONCLUSIONS

Our results indicate separate roles for the antagonists, where DKK1 and GREM1 had similarities in response to injury and in OA, with a different response for FRZB.

On the Backward Euler Approximation of the Stochastic Allen-Cahn Equation

We consider the stochastic Allen-Cahn equation perturbed by smooth additive Gaussian noise in a spatial domain with smooth boundary in dimension d ≤ 3, and study the semidiscretization in time of the equation by an implicit Euler method. We show that the method converges pathwise with a rate O(Δtγ) for any γ < ½. We also prove that the scheme converges uniformly in the strong Lp-sense but with no rate given.

Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study

Introduction:

This study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures.

Material and Methods:

In a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months.

Results:

Treatment failed in 3/54 (6%) patients in the active group. One of these patients had the plaster cast reinstituted because of feelings of instability. The fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. For the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. There were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months.

Conclusion:

Treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. The only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. Plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

Surgical reconstruction of ruptured anterior cruciate ligament prolongs trauma-induced increase of inflammatory cytokines in synovial fluid: an exploratory analysis in the KANON trial

OBJECTIVE

Prospectively monitor how treatment of acutely ruptured anterior cruciate ligament (ACL) affects biomarkers of inflammation and proteolytic degradation over 5 years.

DESIGN

We studied 119 subjects with acute ACL injury from the randomized controlled knee anterior cruciate ligament, non-surgical versus surgical treatment (KANON)-trial (Clinical trial ISRCTN 84752559) who had synovial fluid, serum and urine samples available from at least two out of six visits over 5 years after acute ACL rupture. All subjects followed a similar rehabilitation protocol where, according to randomization, 60 also had early ACL reconstruction and 59 had the option to undergo a delayed ACL reconstruction if needed. Interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFNγ), tumor necrosis factor (TNF), amino acids alanine, arginine, glycine, serine (ARGS)-aggrecan, C-terminal crosslinking telopeptide type II collagen (CTX-II) and N-terminal crosslinking telopeptide type I collagen (NTX-I) were quantified by enzyme-linked immunosorbent assays (ELISA).

RESULTS

Subjects randomized to early ACL reconstruction had higher cytokine concentrations in index knee synovial fluid at 4 months (IL-6, IL-8, IL-10, TNF), 8 months (IL-6 and TNF) and at 5 years (IFNγ) compared to those randomized to optional delayed reconstruction. Those that underwent delayed ACL reconstruction within 5 years (30 subjects), had higher synovial fluid concentrations of IL-6 at 5 years compared to those treated with rehabilitation alone. No differences between groups were noted for ARGS-aggrecan in synovial fluid and serum or CTX-II and NTX-I in urine over 5 years, neither as randomized nor as treated.

CONCLUSIONS

Surgical ACL reconstruction constitutes a second trauma to the acutely injured joint resulting in a prolonged elevation of already high synovial fluid levels of inflammatory cytokines.

Search for Cosmic-Ray Electron and Positron Anisotropies with Seven Years of Fermi Large Area Telescope Data

The Large Area Telescope on board the Fermi Gamma-ray Space Telescope has collected the largest ever sample of high-energy cosmic-ray electron and positron events since the beginning of its operation. Potential anisotropies in the arrival directions of cosmic-ray electrons or positrons could be a signature of the presence of nearby sources. We use almost seven years of data with energies above 42 GeV processed with the Pass 8 reconstruction. The present data sample can probe dipole anisotropies down to a level of 10^{-3}. We take into account systematic effects that could mimic true anisotropies at this level. We present a detailed study of the event selection optimization of the cosmic-ray electrons and positrons to be used for anisotropy searches. Since no significant anisotropies have been detected on any angular scale, we present upper limits on the dipole anisotropy. The present constraints are among the strongest to date probing the presence of nearby young and middle-aged sources.

Processionary Moths and Associated Urtication Risk: Global Change-Driven Effects

Processionary moths carry urticating setae, which cause health problems in humans and other warm-blooded animals. The pine processionary moth Thaumetopoea pityocampa has responded to global change (climate warming and increased global trade) by extending its distribution range. The subfamily Thaumetopoeinae consists of approximately 100 species. An important question is whether other processionary moth species will similarly respond to these specific dimensions of global change and thus introduce health hazards into new areas. We describe, for the first time, how setae are distributed on different life stages (adult, larva) of major groups within the subfamily. Using the available data, we conclude that there is little evidence that processionary moths as a group will behave like T. pityocampa and expand their distributional range. The health problems caused by setae strongly relate to population density, which may, or may not, be connected to global change.

Low-dose developmental exposure to bisphenol A alters the femoral bone geometry in wistar rats

BACKGROUND

Bisphenol A (BPA) is a chemical produced in large volumes for use in manufacturing of consumer products and industrial applications, and an endocrine disruptor known to affect several hormonal systems. Bone produces hormones and is additionally a sensitive hormone target tissue, and is thus potentially sensitive to low doses of endocrine disruptors such as BPA, especially during development.

METHODS

110 pregnant Wistar rats were gavaged with 0; 25 μg; 250 μg; 5000 μg or 50,000 μg BPA/kg bodyweight (bw)/day from gestational day 7 until weaning at postnatal day 22. The three-month-old offspring were sacrificed and right femurs collected for length measurements, geometrical measurements by peripheral quantitative computed tomography (pQCT), as well as for analyses of biomechanical properties using the three-point-bending method.

RESULTS

The femur was elongated in female offspring of dams exposed to 25 or 5000 μg BPA/kg bw/day (1.8% and 2.1%, respectively), and increased cortical thickness (4.7%) was observed in male offspring of dams exposed to 25 μg BPA/kg bw/day, compared to controls (p < 0.005). The biomechanical properties of the bone were not significantly altered.

CONCLUSIONS

In utero and lactational exposure to the lowest BPA dose used in this study altered femoral geometry in both male and female offspring. This was observed at 25 μg BPA/kg bw/day, a dose lower than the Human Equivalent Dose (HED) applied by EFSA to set a temporary TDI (609 μg BPA/kg bw/day), and far lower than the No-Observed-Adverse-Effect-Level (NOAEL) (5000 μg BPA/kg bw/day) on which the US FDA TDI is based.

Stability of Internally Fixed Femoral Neck Fractures Augmented with Resorbable Cement

Background and Aims:

Internal fixation of displaced femoral neck fractures is associated with a high risk for complications such as non-union or avascular necrosis. A stable fracture fixation can improve prognosis although stability is often counteracted by weak osteoporotic bone. The aim with this study was to evaluate whether augmentation with resorbable calcium-phosphate cement could improve fracture stability during the early period after surgery as shown in biomechanical studies.

Material and Methods:

40 ambulatory patients with a displaced femoral neck fracture were randomized to treatment with cannulated screws alone (controls) or screws combined with calcium-phosphate cement for augmentation (augmented). All patients were allowed unrestricted weight bearing after surgery. Fracture movement was measured with radiostereometry (RSA) at 1 and 6 weeks.

Results:

At 1 week the augmented fractures had moved on average 1.9±1.0 mm while movement in the controls was 5.5±3.4 mm (p < 0.0001). The average total movement at weeks was 6.9±2.9 mm and 10.9±5.1 mm, respectively (p < 0.005). Varus angulation and distal migration of the femoral head were the most common movements for both groups although augmented fractures had moved significantly less at both 1 and 6 weeks. There were no significant differences in angulation between groups around the longitudinal and transversal axes or in migration along the transverse or sagittal axes.

Conclusion:

Augmentation with calcium-phosphate cement improved the stability of internally fixed femoral neck fractures during the first six weeks after surgery, with improvement being less pronounced at six weeks compared with at one week.

Unstable Trochanteric Fractures Augmented with Calcium Phosphate Cement

Background and Aims:

Internally fixed unstable trochanteric fractures might be difficult to retain in position during healing. Secondary displacement might lead to malunion and poor functional result. The aim with this study was to measure whether augmentation with resorbable calcium-phosphate cement could improve fracture stability as shown in biomechanical studies.

Material and Methods:

26 ambulatory patients with an unstable trochanteric fracture were randomized to treatment with a sliding screw device alone (Controls) or the same device combined with calcium-phosphate cement for augmentation (Augmented). All patients were allowed unrestricted weight bearing after surgery. Fracture movement was measured with radiostereometry (RSA) at 1 and 6 weeks and at 6 months.

Results:

Two patients died during the study period due to unrelated causes and another three were excluded due to technical problems with the RSA in two and concomitant illness in one. 21 patients (11 Augmented and 10 Controls) were followed according to the study protocol. At 1 week the augmented fractures had moved on average 1.9 ± 1.7 mm while movement in the controls was 4.0 ± 2.4 mm (p < 0.05). The average total movement from the day after surgery until 6 months, when all fractures had healed, was 7.8 ± 6.2 mm for the augmented fractures and 13.2 ± 4.3 mm for the controls (p < 0.05). Varus angulation was the most pronounced rotational movement for both groups although augmented fractures revealed less varus angulation compared with controls at all time points. Rotation around the longitudinal and transversal axes were small with no significant differences between treatment groups.

Conclusion:

Augmentation with calcium-phosphate cement improved the stability of unstable trochanteric fractures fixed with a sliding screw device. The improvement was most pronounced for varus angulation and lateral and distal migration of the head and neck fragment.

Value of air trapping in detection of small airways disease in smokers

Purpose: To test the hypothesis that diffuse and/or focal air trapping are sensitive indicators of airflow obstruction in smoker's small airways disease, when age, gender and presence of emphysematous lesions were allowed for.

Material and Methods: Fifty-eight smokers and 34 never smokers, recruited from a randomized population study of men born in 1933, were investigated by HRCT and by extended pulmonary function tests, including a sensitive test for small airways disease (N2 slope). Diffuse air trapping was evaluated by calculating a quotient of mean lung density at expiration and inspiration. Focal air trapping was scored visually by consensus.

Results: Diffuse air trapping did not differ between non-emphysematous smokers and never smokers. Furthermore, diffuse air trapping correlated well to the quotient between the residual volume and total lung capacity (RV/TLC, p = 0.01) and was consequently higher in emphysematous smokers than in never smokers.

Focal air trapping was found as frequently in smokers without emphysema as in never smokers. Smokers with emphysema showed significantly less focal air trapping. Neither the N2 slope nor any of the other lung function variables differed between those with and without focal air trapping among non-emphysematous smokers.

Conclusion: Neither diffuse nor focal air trapping are sensitive indicators of smoker's small airways disease.

Short rotation plantations policy history in Europe: lessons from the past and recommendations for the future

Short rotation plantations (SRPs) are fast-growing trees (such as willow (Salix spp.), poplar (Populus spp.) and Eucalyptus) grown closely together and harvested in periods of 2-20 years. There are around 50,000 hectares of SRPs in Europe, a relatively small area considering that there have been supportive policy measures in many countries for 30 years. This paper looks at the effect that the policy measures used in different EU countries have had, and how other external factors have impacted on the development of the industry. Rokwood was a 3-year European funded project which attempted to understand the obstacles and barriers facing the woody energy crops sector using well established methods of SWOT and PESTLE analysis. Stakeholder groups were formed in six different European regions to analyze the market drivers and barriers for SRP and propose ways that the industry could make progress through targeted research and development and an improved policy framework. Based upon the outcomes of the SWOT and PESTLE analysis, each region produced a series of recommendations for policymakers, public authorities, and government agencies to support the development, production, and use of SRP-derived wood fuel in each of the partner countries. This study provides details of the SRP policy analysis and reveals that each region shared a number of similarities with broad themes emerging. There is a need to educate farmers and policymakers about the multifunctional benefits of SRPs. Greater financial support from regional and/or national government is required in order to grow the SRP market. Introducing targeted subsidies as an incentive for growers could address lack of local supply chains. Long-term policy initiatives should be developed while increasing clarity within Government departments. Research funding should enable closer working between universities and industry with positive research findings developed into supportive policy measures.

Unrestricted Weight Bearing and Intensive Physiotherapy after Uncemented Total Hip Arthroplasty

Background and Aims:

The effectiveness of partial weightbearing after hip surgery has been questioned as well as the need of intensive physiotherapy.

Material and Methods:

36 patients (average age 54.4, 19 women) operated with uncemented hip arthroplasty were randomized either to unrestricted weightbearing (UWB) combined with intensive physiotherapy or to partial weightbearing (PWB) for 3 months combined with a short self-training program. The load during walking and the muscle strength (MS) in abduction was measured preoperative and subsequent up to 12 months.

Results:

The average peak load on the operated leg at one week was 39.0 kg for the UWB and 25.8 for the PWB group (P = 0.009) while at three months 70.0 and 31.7 (P = 0.001) respectively. At 6 and 12 months there were no differences between the groups. The muscle strength increased in both groups up to six months but there were no differences between the groups.

Conclusions:

Even though patients applied more load than the recommended 15 kg most patients were able to comply with partial weightbearing fairly well. The effect of intensive physiotherapy on the muscle strength after hip arthroplasty is questionable.