Double-blinded, randomised, placebo-controlled trial of convalescent plasma for COVID-19: analyses by neutralising antibodies homologous to recipients' variants

INTRODUCTION

Convalescent plasma (CP) emerged as potential treatment for COVID-19 early in the pandemic. While efficacy in hospitalised patients has been lacklustre, CP may be beneficial at the first stages of disease. Despite multiple new variants emerging, no trials have involved analyses on variant-specific antibody titres of CP.

METHODS

We recruited hospitalised COVID-19 patients within 10 days of symptom onset and, employing a double-blinded approach, randomised them to receive 200 ml convalescent plasma with high (HCP) or low (LCP) neutralising antibody (NAb) titre against the ancestral strain (Wuhan-like variant) or placebo in 1:1:1 ratio. Primary endpoints comprised intubation, corticosteroids for symptom aggravation, and safety assessed as serious adverse events. For a preplanned ad hoc analysis, the patients were regrouped by infused CP's NAb titers to variants infecting the recipients i.e. by titres of homologous HCP (hHCP) or LCP (hLCP).

RESULTS

Of the 57 patients, 18 received HCP, 19 LCP and 20 placebo, all groups smaller than planned. No significant differences were found for primary endpoints. In ad hoc analysis, hHCPrecipients needed significantly less respiratory support, and appeared to be given corticosteroids less frequently (1/14; 7.1%) than those receiving hLCP (9/23; 39.1%) or placebo (8/20; 40%), (p = 0.077).

DISCUSSION

Our double-blinded, placebo-controlled CP therapy trial remained underpowered and does not allow any firm conclusions for early-stage hospitalised COVID-19 patients. Interestingly, however, regrouping by homologous - recipients' variant-specific - CP titres suggested benefits for hHCP. We encourage similar re-analysis of ongoing/previous larger CP studies.

TRIAL REGISTRATION

ClinTrials.gov identifier: NCT0473040.

Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial

OBJECTIVE

The primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee.

DESIGN

Prospective, randomised, 2 years, assessor-blind, multicentre, superiority trial.

SETTING

The patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland).

PARTICIPANTS

We recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis.

INTERVENTIONS

All patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up.

MAIN OUTCOME MEASURES

Primary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements.

RESULTS

The primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI -0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI -4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI -0.6 to 9.2) for function in daily living, 4.3 points (95% CI -3.0 to 11.6) for function in sports, and 2.1 points (95% CI -4.8 to 9.1) for knee-related quality of life.

CONCLUSIONS

The recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years.

TRIAL REGISTRATION NUMBER

NCT02481427.

The efficacy of probiotics and/or n-3 long-chain polyunsaturated fatty acids intervention on maternal prenatal and postnatal depressive and anxiety symptoms among overweight and obese women

BACKGROUND

Maternal depression and anxiety may endanger well-being of both mother and child. We investigated the efficacy of probiotics and/or fish oil (FO) in modifying pre- and postnatal depressive and anxiety symptoms. Symptom trajectories were identified and the influence of lifestyle factors on symptoms was evaluated.

METHODS

Overweight women (n = 439) were randomized to intervention groups (probiotics+FO, probiotics+placebo, FO+placebo, placebo+placebo) from early pregnancy until six months postpartum, and assessed for depressive and anxiety symptoms with Edinburgh Postnatal Depression Scale (EPDS) and Anxiety subscale of Symptoms Checklist (SCL-90) at early and late pregnancy and three, six and 12 months postpartum. Latent growth mixture modeling was used to model the symptom courses. Dietary quality and physical activity were assessed with validated indices.

RESULTS

Symptom scores were generally low. Statistically significant intervention effect was seen during pregnancy (p = 0.017): EPDS scores increased (by 1.11 points) in the FO+probiotics group and decreased (by 0.85 points) in the FO+placebo group. At 12 months postpartum, FO+placebo group had lower EPDS scores compared to probiotics+placebo group (p = 0.039). No differences in SCL scores were seen in response to the intervention. Irrespective of the intervention, three depressive and two anxiety symptoms trajectories were identified. Dietary quality correlated negatively with depressive symptoms in early pregnancy and six months postpartum and with anxiety symptoms in early pregnancy. Perinatal events including mother-reported colic were related to symptoms.

LIMITATIONS

Secondary outcomes of the primary trial.

CONCLUSIONS

Intervention had a modest impact on depressive symptoms. Diet and obstetric events were associated with depressive and anxiety symptoms.

Characteristics of clinically node negative breast cancer patients needing preoperative MRI

BACKGROUND

International guidelines do not recommend magnetic resonance imaging (MRI) for all breast cancer patients at primary diagnostics. This study aimed to understand which patient or tumor characteristics are associated with the use of MRI. The role of MRI among other preoperative imaging methods in clinically node negative breast cancer was studied.

MATERIAL AND METHODS

Patient and tumor characteristics were analyzed in association with the use of MRI by multivariable logistic regression analysis in 461 patients. Primary tumor size was compared between MRI, mammography (MGR), ultrasound (US) and histopathology by Spearman correlation. The delays in surgery and diagnosis were analyzed among patients with or without MRI, and axillary reoperations were evaluated.

RESULTS

Age (p < 0.0001), primary operation method (p < 0.0001), tumor histology (p < 0.0001) and HER2 status (p = 0.0064) were associated with the use of MRI. Spearman correlations between tumor size in histopathology and the difference in tumor size between histopathology and imaging methods were 0.52 in MGR, 0.66 in US and 0.36 in MRI (p < 0.0001 for all). A seven-day delay in surgical treatment was observed among patients with MRI compared to patients without MRI (p < 0.0001). Axillary reoperation rates were similar in patients with or without MRI (p = 0.57).

CONCLUSION

Patient selection through prearranged characterization is important in deciding on optimal candidates for preoperative MRI among breast cancer patients. MRI causes moderate delays in primary breast cancer surgery. Preoperative MRI is useful in the evaluation of tumor size but might be insufficient in detecting lymph node metastases.

Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age

OBJECTIVE

To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed.

METHODS

Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7-16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1-3 months post-injury and later visits to psychiatric care.

RESULTS

According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1-3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care.

CONCLUSIONS

Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.

Associating school doctor interventions with the benefit of the health check: an observational study

Background

In Finland, most school doctor resources are dedicated to general health checks at predetermined ages in addition to annual health checks by school nurses. This study explored the association of school doctor interventions with the doctor- and the parent-evaluated benefit of the appointment.

Methods

Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades one and five, aged seven and eleven years, respectively, from 21 Finnish elementary schools in four municipalities. Doctors routinely examined all children accompanied by parents and reported their interventions. They estimated the benefit/harm of the appointment according to predetermined criteria, whereas parents provided their subjective perceptions. Multilevel logistic regression was used for comparisons.

Results

The doctors conducted interventions for 78% of the participating 1013 children. The interventions included: referrals to secondary care (5%), laboratory tests or medical imaging (8%), prescriptions (10%), referrals to experts (13%), instructions/significant discussions (60%), and additional appointments (17%). The doctors and parents found 41% and 83% of the health checks beneficial, respectively. The doctors reported 52% and the parents 87% of the appointments with interventions beneficial. The doctors considered none and the parents 68% of the appointments with no interventions beneficial. All interventions were associated with the doctor-evaluated benefit. All interventions except referrals to secondary care, guidance to experts, and additional appointments were associated with the parent-evaluated benefit.

Conclusions

Parents valued immediate help and testing from the doctor instead of referrals to other experts or follow-up. Doctors mostly valued the appointments that required their expertise. These findings support the evidence for directing school doctor resources to the children who need doctor's expertise.

Key messages

Parents could benefit from information when school doctor’s expertise is pivotal. Doctors are frequently not essential in general health checks of elementary school children. This supports the evidence for focusing school doctor resources to the children who need them most.

Healthy learning mind - Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial

BACKGROUND

Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial.

METHODS

Finnish school children and adolescents (N = 3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26).

RESULTS

Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=-0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=-1.37, SE 0.69, p = 0.049) and at T26 (β=-1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation.

LIMITATIONS

The inactive control group was smaller than the intervention and active control groups, reducing statistical power.

CONCLUSIONS

A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.

Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study

INTRODUCTION

The highly selective α₂-agonist dexmedetomidine has become a popular sedative for neurointensive care patients. However, earlier studies have raised concern that dexmedetomidine might reduce cerebral blood flow without a concomitant decrease in metabolism. Here, we compared the effects of dexmedetomidine on the regional cerebral metabolic rate of glucose (CMR_glu) with three commonly used anaesthetic drugs at equi-sedative doses.

METHODS

One hundred and sixty healthy male subjects were randomised to EC₅₀ for verbal command of dexmedetomidine (1.5 ng ml^-1; n=40), propofol (1.7 μg ml^-1; n=40), sevoflurane (0.9% end-tidal; n=40) or S-ketamine (0.75 μg ml^-1; n=20) or placebo (n=20). Anaesthetics were administered using target-controlled infusion or vapouriser with end-tidal monitoring. ¹⁸F-labelled fluorodeoxyglucose was administered 20 min after commencement of anaesthetic administration, and high-resolution positron emission tomography with arterial blood activity samples was used to quantify absolute CMR_glu for whole brain and 15 brain regions.

RESULTS

At the time of [F¹⁸]fluorodeoxyglucose injection, 55% of dexmedetomidine, 45% of propofol, 85% of sevoflurane, 45% of S-ketamine, and 0% of placebo subjects were unresponsive. Whole brain CMR_glu was 63%, 71%, 71%, and 96% of placebo in the dexmedetomidine, propofol, sevoflurane, and S-ketamine groups, respectively (P<0.001 between the groups). The lowest CMR_glu was observed in nearly all brain regions with dexmedetomidine (P<0.05 compared with all other groups). With S-ketamine, CMR_glu did not differ from placebo.

CONCLUSIONS

At equi-sedative doses in humans, potency in reducing CMR_glu was dexmedetomidine>propofol>ketamine=placebo. These findings alleviate concerns for dexmedetomidine-induced vasoconstriction and cerebral ischaemia.

CLINICAL TRIAL REGISTRATION

NCT02624401.

The effect of low-dose aspirin on serum placental growth factor levels in a high-risk PREDO cohort

OBJECTIVES

Our first aim was to study the longitudinal changes of serum placental growth factor (PlGF) concentration between 12⁺⁰ and 28⁺⁰ weeks of gestation in the prospective PREDO cohort. Our second aim was to study the effect of low-dose acetylsalicylic acid (LDA; 100 mg/day), started before the 14th week of gestation, on PlGF concentration.

STUDY DESIGN

Blood samples were collected at 12⁺⁰-14⁺⁰, 18⁺⁰-20⁺⁰ and 26⁺⁰-28⁺⁰ weeks of gestation in 101 women without and 309 with clinical risk factors for pre-eclampsia. Risk-women were divided into two groups: to those who had medium risk for pre-eclampsia and to those who had high risk for pre-eclampsia. Finally there were seven groups according to risk, treatment (no prevention/placebo/LDA) and outcome measure pre-eclampsia. Longitudinal changes in the PlGF concentration between groups were compared. To investigate the effect of LDA on serum PlGF concentration, placebo (N = 62) and LDA (N = 61) groups were compared. A repeated measures ANOVA was used to analyze differences in PlGF levels between the groups.

RESULTS

The increase in serum PlGF concentration was higher in LDA than in placebo group (time × group effect, p = 0.046). The increase in serum PlGF concentration during pregnancy was lower in high-risk women who had placebo and developed pre-eclampsia and in medium-risk women who developed pre-eclampsia compared to the other women (time × group effect, p < 0.001). There were no differences in PlGF change between low-risk women, medium-risk women who did not develop pre-eclampsia, high-risk women in the placebo group without pre-eclampsia and high-risk women in the LDA group with and without pre-eclampsia (p = 0.15).

CONCLUSIONS

Our finding suggests an association between LDA started before 14 weeks of gestation and higher increase in serum PlGF concentration.

The impact of probiotics and n-3 long-chain polyunsaturated fatty acids on intestinal permeability in pregnancy: a randomised clinical trial

A disruption in intestinal barrier integrity may predispose individuals to metabolic aberrations, particularly during the vulnerable period of pregnancy. We investigated whether intestinal permeability, as measured by serum zonulin concentration, changes over the duration of pregnancy and whether this change is reflected in lipopolysaccharide (LPS) activity. Second, we tested in a randomised double-blind placebo controlled clinical trial the impact of consuming dietary probiotics and/or long chain polyunsaturated fatty acid (LC-PUFA) supplements in lowering serum zonulin concentration and LPS activity. The probiotic supplement was a combination of two bacteria, Bifidobacterium animalis ssp. lactis 420 and Lactobacillus rhamnosus HN001. This study included 200 overweight pregnant women participating in an on-going study; participants were randomised to consume either (1) probiotics, (2) LC-PUFA, (3) probiotics and LC-PUFA, or (4) placebo for each supplement. Blood samples were obtained at early, the baseline, and late pregnancy (mean 14 and 35 weeks of gestation, respectively). Serum zonulin concentration increased from early (mean (standard deviation): 62.7 (12.9) ng/ml) to late pregnancy by 5.3 (95%CI 3.7-6.9) ng/ml, and LPS activity increased from (0.16 (0.04) EU/ml) by 0.04 (95%CI 0.03-0.05) EU/ml. No differences among the intervention groups were detected in the change from early to late pregnancy in serum zonulin concentration (P=0.8) or LPS activity (P=0.2). The change in serum zonulin concentration during the pregnancy was associated with the weeks of follow up (r=0.25, P<0.001). Serum LPS activity was correlated with higher maternal weight gain (r=0.19, P=0.008). As a conclusion, intestinal permeability increased with the progression of pregnancy in overweight and obese women and was reflected in LPS activity. No efficacy of supplementation with probiotics and/or LC-PUFA was demonstrated in pregnancy-induced changes in serum zonulin concentration or LPS activity.

Systematic Screening of Adverse Reactions to Metal Debris after Recap-M2A-Magnum Metal-on-Metal Total Hip Arthroplasty

Background and Aims:

An adverse reaction to metal debris is a known complication after large diameter head metal-on-metal total hip arthroplasty. However, the failure rate varies depending on the implant design. Therefore, we investigated the prevalence of adverse reaction to metal debris, as well as the symptoms and risk factors after undergoing a ReCap-M2a-Magnum large diameter head metal-on-metal total hip arthroplasty.

Materials and Methods:

Between 2005 and 2012, 1188 patients (1329 hips) underwent ReCap-M2a-Magnum total hip arthroplasty at our institution. Systematic screening for adverse reaction to metal debris was arranged using the Oxford Hip Score questionnaire, hip and pelvic radiographs, and assessments of the serum chromium and cobalt ion levels. Clinical evaluation and magnetic resonance imaging were performed for the symptomatic patients, as well as those with either chromium or cobalt ion levels ⩾5 µg/L. The prevalence of adverse reaction to metal debris after ReCap-M2a-Magnum total hip arthroplasty was assessed, and the risk factors for adverse reaction to metal debris were evaluated using logistic regression. The mean follow-up time was 5.2 (0.003–9.1) years. This study was an extension of a previous study conducted at our institution with 80 patients.

Results:

In total, 33 patients (33 hips, 2.5% of all hips) required a revision operation due to adverse reaction to metal debris. Moreover, 157 hips exhibited definitive adverse reaction to metal debris, but a revision operation was not performed (157 of 1329 hips, 11.8% of all hips). Overall, 190 out of 1329 (14.3%) hips had definitive adverse reaction to metal debris. Pain, subluxation sensation, clicking, swelling, a small head size, and a fair/poor Oxford Hip Score were associated with definitive adverse reaction to metal debris.

Conclusion:

We found a high prevalence of adverse reaction to metal debris in the ReCap-M2a-Magnum total hip arthroplasty patients in this study; however, most of the patients did not require revision operations.

Adolescent Disc Degeneration - No Headache Association

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month ( N = 47) and adolescents with no headache ( N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.

Outcome of Headache Frequency in Adolescence

Only a few studies have been published of the outcome of adolescent headache (HA). The aim of this study was to examine the predictors of the outcome of headache frequency. A population-based sample of 13-year-olds with or without HA ( N = 228) was followed to the age of 16 years. HA was classified on the basis of a face-to-face interview and clinical examination. The outcomes of monthly HA (>1/month) and non-frequent HA (0-1/month) were studied. Frequent use of analgesics, female gender and multiple non-headache pain predicted the persistence of monthly HA (>1/month). Significant predictors for worsening non-frequent HA (from 0 to 1/month to >1/month) were female gender, consistent migraine and high basic educational level of one parent. Adolescents frequently using analgesics constitute a risk group for a poor outcome of HA. Especially girls meeting this criterion should be considered a target group in the planning and implementing of preventive measures.

Characteristics of Neck Pain Associated With Adolescent Headache

The objective of the study was to find out what kind of neck pain (NP) is associated with headache (HA) and with various headache variables: frequency, type, intensity, disturbance, and relief with analgesics. A population-based sample of 12-year-olds with and without HA ( n = 304) was followed for 4 years. At the age of 16 years, NP was evaluated on the basis of self-reported symptoms and a thorough physical examination of the neck region. Both self-reported and measured NP were associated with HA variables. Co-occurrent NP was found in adolescents with migraine as often as in those with tension-type HA. Especially, muscle pain and intensive, frequent NP were associated with disturbing HA unresponsive to analgesics. The study indicates that concomitant NP should be considered in adolescent HA sufferers, and a thorough cervical and muscle evaluation is recommended when planning the treatment of HA.

Improved Survival in Male Melanoma Patients in the Era of Sentinel Node Biopsy

BACKGROUND AND AIMS

Sentinel node biopsy is a standard method for nodal staging in patients with clinically localized cutaneous melanoma, but the survival advantage of sentinel node biopsy remains unsolved. The aim of this case-control study was to investigate the survival benefit of sentinel node biopsy.

MATERIALS AND METHODS

A total of 305 prospective melanoma patients undergoing sentinel node biopsy were compared with 616 retrospective control patients with clinically localized melanoma whom have not undergone sentinel node biopsy. Survival differences were calculated with the median follow-up time of 71 months in sentinel node biopsy patients and 74 months in control patients. Analyses were calculated overall and separately in males and females.

RESULTS

Overall, there were no differences in relapse-free survival or cancer-specific survival between sentinel node biopsy patients and control patients. Male sentinel node biopsy patients had significantly higher relapse-free survival ( P = 0.021) and cancer-specific survival ( P = 0.024) than control patients. In females, no differences were found. Cancer-specific survival rates at 5 years were 87.8% in sentinel node biopsy patients and 85.2% in controls overall with 88.3% in male sentinel node biopsy patients and 80.6% in male controls and 87.3% in female sentinel node biopsy patients and 89.8% in female controls.

CONCLUSION

Sentinel node biopsy did not improve survival in melanoma patients overall. While females had no differences in survival, males had significantly improved relapse-free survival and cancer-specific survival following sentinel node biopsy.

Distinct regulation of tonsillar immune response in virus infection

Background

The relationships between tonsillar immune responses, and viral infection and allergy are incompletely known.

Objective

To study intratonsillar/nasopharyngeal virus detections and in vivo expressions of T‐cell‐ and innate immune response‐specific cytokines, transcription factors, and type I/II/III interferons in human tonsils.

Methods

Palatine tonsil samples were obtained from 143 elective tonsillectomy patients. Adenovirus, bocavirus‐1, coronavirus, enteroviruses, influenza virus, metapneumovirus, parainfluenza virus, rhinovirus, and respiratory syncytial virus were detected using PCR. The mRNA expression levels of IFN‐α, IFN‐β, IFN‐γ, IL‐10, IL‐13, IL‐17, IL‐28, IL‐29, IL‐37, TGF‐β, FOXP3, GATA3, RORC2, and Tbet were directly analyzed by quantitative RT‐PCR.

Results

Fifty percentage of subjects reported allergy, 59% had ≥1 nasopharyngeal viruses, and 24% had ≥1 intratonsillar viruses. Tonsillar virus detection showed a strong negative association with age; especially rhinovirus or parainfluenza virus detection showed positive association with IFN‐γ and Tbet expressions. IL‐37 expression was positively associated with atopic dermatitis, whereas IFN‐α, IL‐13, IL‐28, and Tbet expressions were negatively associated with allergic diseases. Network analyses demonstrated strongly polarized clusters of immune regulatory (IL‐10, IL‐17, TGF‐β, FOXP3, GATA3, RORC2, Tbet) and antiviral (IFN‐α, IFN‐β, IL‐28, IL‐29) genes. These two clusters became more distinctive in the presence of viral infection or allergy. A negative correlation between antiviral cytokines and IL‐10, IL‐17, IL‐37, FOXP3, and RORC2 was observed only in the presence of viruses, and interestingly, IL‐13 strongly correlated with antiviral cytokines.

Conclusions

Tonsillar cytokine expression is closely related to existing viral infections, age, and allergic illnesses and shows distinct clusters between antiviral and immune regulatory genes.

Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: A prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up

BACKGROUND AND AIMS

The long-term efficacy of laparoscopic Roux-en-Y gastric bypass in the treatment of morbid obesity has already been demonstrated. Laparoscopic sleeve gastrectomy has shown promising short-term results, but the long-term efficacy is still unclear. The aim of this prospective randomized multicenter study is to compare the results of Roux-en-Y gastric bypass and sleeve gastrectomy.

MATERIAL AND METHODS

A total of 240 morbidly obese patients were randomized to undergo either Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point of study was weight loss, and the secondary end points were resolution of comorbidities and morbidity. The short-term results at 6 months were analyzed.

RESULTS

The mean excess weight loss at 6 months was 49.2% in the sleeve gastrectomy group and 52.9% in the Roux-en-Y gastric bypass group (p = 0.086). Type 2 diabetes was resolved or improved in 84.3% of patients in the sleeve gastrectomy group and 93.3% in the Roux-en-Y gastric bypass group (p = 0.585). The corresponding results for arterial hypertension were 76.8% and 81.9% (p = 0.707) and for hypercholesterolemia 64.1% and 69.0% (p = 0.485). There was no mortality at 6 months. There was one major complication following sleeve gastrectomy and two after Roux-en-Y gastric bypass (p = 0.531). Eight sleeve gastrectomy patients and 11 Roux-en-Y gastric bypass patients had minor complications (p = 0.403).

CONCLUSION

The short-term results of sleeve gastrectomy and Roux-en-Y gastric bypass regarding weight loss, resolution of obesity-related comorbidities and complications were not different at 6 months.

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three Designs from the Finnish Arthroplasty Register

Background and Aims:

Large headed metal-on-metal total hip arthroplasty may produce more metal ions than hip resurfacing arthroplasty. Increased metal-ion levels may be associated with higher revision rates due to adverse reaction to metal debris. The purpose of our study was to compare the survivorship of three hip resurfacing arthroplasty designs with their analogous cementless large-diameter head metal-on-metal total hip arthroplasties.

Material and Methods:

Based on data obtained from the Finnish Arthroplasty Register, the revision risks of three metal-on-metal hip resurfacing arthroplasty/total hip arthroplasty design couples performed during 2001–2011 were analyzed using the Cox regression model.

Results:

In the Cox regression analysis for compared design pairs adjusted for age, gender, operated side, head size, diagnosis, and implant, there was no statistically significant difference in revision risk between ReCap hip resurfacing arthroplasty and Bimetric/ReCap total hip arthroplasty (risk ratio = 1.43, confidence interval = 0.95–2.14, p = 0.09) or between Birmingham hip resurfacing arthroplasty and Synergy/Birmingham hip resurfacing total hip arthroplasty (risk ratio = 1.35, confidence interval = 0.75–2.43, p = 0.31). However, the revision risk of Corail and Summit/articular surface replacement total hip arthroplasty (ASR HRA) was significantly increased compared to ASR HRA. (risk ratio = 0.73, confidence interval = 0.54–0.98, p = 0.04).

Conclusion:

We conclude that the short-term revision risk of large headed metal-on-metal total hip arthroplasties was not increased compared to analogous hip resurfacing arthroplasties in two out of three devices studied at a nationwide level. There may be implant-related factors having an effect on the success of single manufacturer devices. However, more information on the incidence of adverse soft-tissue reactions in these patient cohorts is needed.

Experience of structural onlay allografts for the treatment of bone deficiency in revision total hip arthroplasty

Background and Aims:

Loss of femoral bone stock in elective revision total hip arthroplasty poses unique and substantial challenges. Structural onlay allografts may provide mechanical stability for the cementless revision prosthesis and increase bone stock.

Material and methods:

At least one cortical onlay allograft was used in 40 elective total hip arthroplasty revisions (40 patients) to reconstruct femoral bone defects. The operations were performed between January 1999 and August 2010 in the Turku University Hospital, Finland. The mean follow-up time was 52 months (range: 12–125 months).

Results:

The allografts were incorporated into the bone tissue in 37 of 40 (92.5%) patients. Cementless revision stems healed in 36 of 40 (90.0%) patients, but these patients were not exactly the same patients whose allografts were successfully incorporated. One or more surgical complications were experienced by 14 of 40 (35.0%) patients during follow-up. In all, 4 of 40 (10.0%) patients (all women) had hip infections during follow-up. Of the 7 patients with rheumatoid arthritis, 4 (57.1%) had at least one complication.

Conclusions:

The use of the cortical onlay allografts provides a feasible option for restoring the integrity of the proximal femur in revision total hip arthroplasty, but the complication rate is high, particularly in female patients with rheumatoid arthritis.

Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project

AIM

This was to compare the effect of a prevention program between children of anxious and non-anxious mothers.

METHODS

Mothers (n=120) with high and low dental anxiety scores (DAS>15 and DAS <8, respectively), and with high levels of mutans streptococci (>10(5)cfu/mL) were recruited at a maternity clinic of Tartu, Estonia. Two groups: 30 highly anxious, and 30 non-anxious mothers used xylitol (6 g/day) for 33 months and a non-treatment group of 60 mothers, both highly and low anxious (30 in each sub-group), acted as controls. All mothers were interviewed for oral health habits and education, and their dental health was examined. Due to discontinued participation 75% of the children (n=90) were examined at 2 and at 3 years of age.

RESULTS

Anxious mothers brushed less frequently (p=0.014), had a longer time since their last dental visit (p<0.0001), and a lower level of education (p<0.0001) than their non-anxious counterparts. However, maternal anxiety had no effect on children's dental health, contrary to the caries prevention program which was effective both at 2 and at 3 years of age (p<0.01; OR 6.6, 1.8-25.0 and OR 3.9, CI 1.5-10.0, respectively).

CONCLUSION

Children benefited from the caries prevention program, irrespective of maternal anxiety.

Metformin vs. insulin in gestational diabetes. A randomized study characterizing metformin patients needing additional insulin

AIMS

We compared metformin with insulin as treatment of gestational diabetes mellitus (GDM). Furthermore, we aimed to characterize metformin-treated patients needing additional insulin to achieve prespecified glucose targets.

METHODS

We conducted a single centre randomized controlled study with non-inferiority design comparing metformin and insulin in the treatment of 217 GDM patients having birth weight as primary outcome variable.

RESULTS

There were no significant differences in mean birth weight expressed in grams [+15 (90% confidence interval (CI): -121 to 89)] or SD units [+0.04 (90% CI: -0.27 to 0.18)] between the metformin and insulin groups. There were no significant differences in neonatal or maternal data between the groups. Only 23 (20.9%) of the 110 patients in the metformin group needed additional insulin. Compared with the patients on metformin only, those needing additional insulin were older (p = 0.04), their oral glucose tolerance test had been performed earlier and diabetes therapy started earlier in gestation (p = 0.01 and p = 0.004, respectively). The risk for additional insulin was 4.6-fold in women with baseline serum fructosamine concentration above median compared with those below median.

CONCLUSIONS

Metformin is an effective alternative to insulin in the treatment of GDM patients. Serum fructosamine may help in predicting the adequacy of metformin treatment alone.

Hearing aid compliance in the elderly

OBJECTIVES

A decreasing but still substantial proportion of elderly persons with hearing aids use them only occasionally. Because the prevalence of age-related hearing loss is increasing, it is important for the hearing rehabilitation process to be effective. The aim of this study was to use a mailed questionnaire to evaluate the rate of hearing aid use and the reasons for minimal use or nonuse.

METHODS

Questions about hearing aid use and associated problems were included in a survey of hearing mailed to 4,067 people in age cohorts of 70, 75, 80 and 85 years in an industrialized urban community in Finland.

RESULTS

In this sample of 249 hearing aid users, 55.4% used their hearing aid daily, and 27.3% used it > 6 hours a day. The percentage of subjects who never used their hearing aid was 10.7%. Use of hearing aids tended to decline with advancing age. The most common reasons for minimal use were disturbing background noise, acoustic feedback problems, battery cost, and a lack of motivation to use the hearing aid.

CONCLUSIONS

Compliance with hearing aid use by the elderly is increasing, but a significant proportion of hearing aids are still used only occasionally or never. We discuss methods to improve compliance in this patient group. Our results may be used to reexamine existing procedures for fitting hearing aids for counseling, which may increase patient compliance with hearing aids, leading to greater benefits from their use.

Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study

OBJECTIVES

The soluble form of urokinase-type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection.

DESIGN

A single-centre prospective cohort study.

METHODS

The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay.

RESULTS

The median soluble form of the receptor (suPAR) concentrations in groups 1-5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL(-1) , respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL(-1) , P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL(-1) , P < 0.001). Area under the receiver operating characteristics curve (AUC(ROC) ) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72-0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68-0.81, P < 0.0001). At a cut-off level of 6.4 ng mL(-1) , suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut-off level of 6.6 ng mL(-1) , the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders.

CONCLUSIONS

A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.

High-sensitivity C-reactive protein and ankle brachial index in a finnish cardiovascular risk population

High-sensitivity C-reactive protein (hsCRP) has been previously linked to different forms of vascular disease. However, some studies have not found any relationship between hsCRP and atherosclerosis. Also, studies investigating correlation between hsCRP and ankle brachial index (ABI) are scarce. We studied hsCRP in a cardiovascular risk population with a special interest in correlation between hsCRP and ABI. All men and women aged 45 to 70 years from a rural town Harjavalta, Finland were invited to participate in a population survey. Diabetics and people with known vascular disease were excluded. Seventy-three percent (n = 2085) of the invited persons participated and 70% of the respondents (n = 1496) had at least one risk factor to cardiovascular diseases. These subjects were invited to further examinations. From them we measured ABI, hsCRP, leukocyte count, glucose tolerance, systemic coronary risk evaluation (SCORE), body mass index (BMI), and waist circumference. Mean hsCRP was 1.9 mg/L. Smokers had higher hsCRP (mean 2.2 mg/L) than nonsmokers (mean 1.8 mL/L). hsCRP in women was higher than in men (mean 2.0 mg/L versus 1.8 mg/L). Mean ABI was 1.10, and the prevalence of peripheral arterial disease was 3.1%. ABI correlated weakly with hsCRP (r = -0.077, p = 0.014), leukocyte count (r = -0.107, p = 0.001), and SCORE (r = -0.116, p = 0.001). It did not have correlation between age, weight, BMI, or waist circumference. hsCRP correlated with BMI (r = 0.208, p < 0.0001) and waist circumference (r = 0.325, p < 0.0001). When we excluded subjects with hsCRP >10 mg/L, ABI no longer correlated with hsCRP. In a cardiovascular risk population, hsCRP has only a weak correlation with ABI, and this correlation disappeared when we excluded subject with hsCRP >10 mg/L. Instead, hsCRP was correlated to the measures of obesity (waist circumference and BMI), indicating its role as a marker of adipose tissue-driven inflammation. hsCRP does not seem to be a suitable screening method for peripheral arterial disease.

P5-02-01: ErbB4 Ectodomain as a Biomarker and a Potential Therapeutic Target for Breast Cancer

ErbB4 function is controversial in breast cancer and influenced by alternative splicing of the ERBB4 gene. Here we evaluated the cleavable ErbB4 JM-a isoform as a potential drug target and biomarker. To address ErbB4 cleavage in breast cancer tissues in vivo, extracellular and intracellular cleavage products of ErbB4 were assessed by ELISA and immunohistochemistry using matched serum and tissue samples from a series of 243 breast cancer patients. Elevated serum ectodomain level (≥40 ng/mL) and nuclear immunoreactivity were present in 21% and 52% of the patients, respectively. An elevated serum ErbB4 ectodomain concentration was not associated with tumor nuclear immunoreactivity, but was significantly associated with the premenopausal status at diagnosis (P = 0.04). Estradiol also enhanced ErbB4 cleavage and ErbB4 cleaving enzyme activity in vitro, supporting a role for estrogen signaling in regulation of ErbB4 cleavage. Selective targeting of the cleavable ErbB4 JM-a in human breast cancer cells with an ErbB4 isoform-specific mAb 1479 inhibited ErbB4 cleavage and reduced tumor formation in a mouse xenograft model. Consistent with blocking of ErbB4 cleavage, mutagenesis studies and the 3.4 Å X-ray crystal structure of a complex of the ErbB4 extracellular region and the 1479 Fab localized the binding site of mAb 1479 on ErbB4 to a region on subdomain IV encompassing JM-a-specific residues. These data demonstrate that ErbB4 is cleaved in a subset of breast cancer patients, and suggest that the mechanisms by which mAb 1479 suppresses breast cancer cell growth involves inhibition of ErbB4 cleavage. Serum ErbB4 ectodomain concentration could be used as a biomarker to monitor the activity of compounds, such as mAb 1479, that target ErbB4 cleavage.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-02-01.

Sentinel lymph node biopsy and survival in elderly patients with cutaneous melanoma

BACKGROUND

Sentinel lymph node biopsy (SNB) is a widely adopted staging procedure in patients with cutaneous melanoma. The benefits of SNB have not been evaluated thoroughly in older age groups.

METHODS

This was a two-centre retrospective observational study of patients with melanoma aged at least 70 years undergoing SNB.

RESULTS

A total of 423 patients were included. SNB was successful in 405 patients (95·7 per cent), of whom 88 (21·7 per cent) had sentinel node metastasis. During a median follow-up of 2·5 years, recurrence developed in 80 patients (18·9 per cent). Nodal recurrence developed in eight sentinel node-negative patients, giving a false-negative rate of 8·3 per cent, a sensitivity of 91·7 per cent and an overall diagnostic accuracy of 98·0 per cent. A total of 46 patients (10·9 per cent) died from melanoma and 42 (9·9 per cent) from other causes. At 5 years, the relapse-free survival rate was 80·0 per cent in sentinel node-negative patients and 39 per cent in node-positive patients; cancer-specific survival rates were 88·6 per cent and 46 per cent respectively (P < 0·001). In multivariable analysis, sentinel node metastasis (P < 0·001), a Breslow thickness of at least 2·0 mm (P = 0·007) and presence of ulceration (P = 0·012) were independent prognostic factors for cancer-specific survival.

CONCLUSION

SNB is a feasible and accurate technique for detecting nodal metastases in older patients with melanoma. Sentinel node status is the most important predictor of cancer-specific outcome in the elderly.

Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment

This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fall prevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65 years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals=CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07-63.73) among the users of psychotropics and 8.11 (1.03-63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention.

Amyloid PET imaging in patients with mild cognitive impairment: a 2-year follow-up study

BACKGROUND

Patients with amnestic mild cognitive impairment (MCI) have greater risk of conversion to Alzheimer disease (AD). Increased brain amyloid burden in AD and MCI has been demonstrated with PET using [(11)C] Pittsburgh compound B (PiB) as a tracer.

OBJECTIVE

To evaluate change in β-amyloid deposition in with MCI during 2-year follow-up.

METHODS

Patients with MCI and controls were studied with [(11)C] PiB PET, MRI, and neuropsychometry at baseline and these investigations were repeated in patients with MCI after follow-up.

RESULTS

Those patients with MCI converting to AD during follow-up had greater [(11)C] PiB retention in the posterior cingulate (p=0.020), in the lateral frontal cortex (p=0.006), in the temporal cortex (p=0.022), in the putamen (p=0.041), and in the caudate nucleus (p=0.025) as compared to nonconverters. In converters, there was no significant change in [(11)C] PiB uptake, whereas an increase was seen as compared to baseline in nonconverters in the anterior and posterior cingulate, temporal and parietal cortices, and putamen. Hippocampal atrophy was greater in converters at baseline than in nonconverters, but increased significantly in both groups during follow-up.

CONCLUSIONS

Hippocampal atrophy and amyloid deposition seem to dissociate during the evolution of MCI, the atrophy increasing clearly and [(11)C] PiB retention changing modestly when conversion to AD occurs. Longer follow-up is needed to determine whether nonconverters would convert to AD later, which would suggest accelerated [(11)C] PiB retention preceding clinical conversion.

Cervical hip fracture in a Finnish population: incidence and mortality

BACKGROUND AND AIMS

Our aim was to describe the incidence of cervical hip fractures and to describe the relationships between selected background variables and mortality at 30 days, 6 months, and 3 years postoperatively.

MATERIAL AND METHODS

The basic material consisted of population-based data set of patients aged 65 years or older who had sustained a hip fracture and were treated operatively between 1999 and 2000. Out of these, we identified 266 consecutive patients with cervical hip fracture.

RESULTS

The age-adjusted incidence of cervical hip fractures in women was 1.3-fold compared to men. In age-adjusted analysis, occurrence of chronic lung disease, cardiovascular disease or 2-5 comorbidities, male gender, the need for 2-person mobility assistance, and poor ambulation postoperatively were associated with excess mortality at least at one evaluation point.

CONCLUSIONS

Only chronic lung disease and male gender were independent predictors of increased mortality at each follow-up assessment in multivariate analysis.

The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment

OBJECTIVES

To evaluate the long-term effects of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment.

STUDY DESIGN

A randomized controlled trial.

METHODS

Five hundred and ninety-one community-dwelling elderly people (> or = 65 years) living in the town of Pori, Finland with at least one fall during the previous 12 months were randomized into an intervention group (n=293) and a control group (n=298). Subjects in the intervention group participated in a multifactorial 12-month fall prevention programme. This study evaluated the incidence of falls requiring medical treatment during the 3-year follow-up period.

RESULTS

The intervention did not significantly reduce the incidence of falls requiring medical treatment during the 3-year follow-up period [incidence rate ratio (IRR) for the intervention group compared with the control group 0.87, 95% confidence interval (CI) 0.63-1.21]. The number of falls requiring medical treatment was lower in the intervention group (n=32) compared with the control group (n=50) (IRR 0.65, 95%CI 0.40-1.07) during the second year of follow-up, but this was not found during the first year (48 and 48 falls, respectively; IRR 1.04, 95%CI 0.64-1.69) or the third year (44 and 48 falls, respectively; IRR 0.94, 95%CI 0.58-1.53) of follow-up.

CONCLUSIONS

The multifactorial fall prevention programme did not decrease the incidence of falls requiring medical treatment of fall-prone elderly people during the 3-year follow-up period. However, some positive effect was found during the second year of follow-up (immediately after the 12-month intervention).

Morphometric analysis of CD34-positive vessels in salivary gland adenoid cystic and mucoepidermoid carcinomas

BACKGROUND

Carcinomas of the salivary glands are uncommon and morphologically a diverse group of malignancies. To evaluate the prognostic value of CD34 immunostaining of the vessels in adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC), an automated image analysis method was used.

METHOD

In a nationwide study, covering salivary gland cancer (SGC) patients in Finland 1991-1996, 37 AdCC and 18 MEC patients (M 25, F 30, age 25-90, mean 63) were included. In addition to clinical characteristics the size, shape, staining intensity and vessel density in CD34 immunostained histologic samples were measured.

RESULTS

Altogether 4433 vessels were measured from AdCC and 2615 from MEC tumor. Of the total tumor vessels measured, 2651 were from patients who deceased with disease (Group I) and 4397 were from specimens derived from those who did not die of disease (Group II) during the 10-year follow-up. The staining intensity was significantly higher in MEC than in AdCC tumor (P = 0.0005). In MEC, the Group I patients had a higher staining intensity among high-grade patients compared with patients with low grade disease, whereas the tumors in Group II had a lower staining intensity among the high-grade compared with the low grade tumors (P = 0.018). A higher vessel density was found in patients with MEC in group II compared with group I (P = 0.017).

CONCLUSIONS

The staining intensity of CD34 positive vessels in MEC was higher than in AdCC. In MEC, higher staining intensity of vessels in high-grade tumors and lower vessel density in all MEC patients, predicted poor survival.

Dental fear: one single clinical question for measurement

A new dental fear measurement instrument, the Short Dental Fear Question (SDFQ), was developed and tested for clinical practice purposes. The correlations of the SDFQ with the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) were tested in 15-16-year-old adolescents. The Spearman correlations (rs) between the dental fear measurement instruments were: SDFQ – DFS: r_s = 0.79, n = 26; DFS – DAS: r_s = 0.72, n = 26; SDFQ– DAS: r_s = 0.69, n = 27. DAS and DFS mean scores were clearly higher in the SDFQ fear group than SDFQ in the relaxed group. The SDFQ is a short and compact instrument which might be convenient for the measurement of dental fear in clinical practice.

Severe periprosthetic osteolytic lesions after the Ankle Evolutive System total ankle replacement

Between 2002 and 2008, 130 consecutive ankles were replaced with an hydroxyapatite (HA) and titanium-HA-coated Ankle Evolutive System total ankle prosthesis. Plain radiographs were analysed by two independent observers. Osteolytic lesions were classified by their size and location, with cavities > 10 mm in diameter considered to be ‘marked’. CT scanning was undertaken in all patients with marked osteolysis seen on the plain radiographs.

Osteolytic lesions were seen on the plain films in 48 (37%) and marked lesions in 27 (21%) ankles. The risk for osteolysis was found to be 3.1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating.

Care should be taken with ankle arthroplasty until more is known about the reasons for these severe osteolyses.

Attached to the web--harmful use of the Internet and its correlates

BACKGROUND AND AIMS

The aim of this study was to test the validity of the Finnish version of the Internet Addiction Test and the correlates of harmful use of the Internet.

METHODS

One thousand eight hundred and twenty-five students (45.5% men and 54.5% women, mean age 24.7 years, S.D.=5.7) filled in a web-based questionnaire including IAT, reasons for use of the Internet, distress, social support, and substance use.

RESULTS

Men had a statistically significantly higher mean score on the IAT than women. Subjects with self-reported use of cannabis had higher mean score on the IAT compared to non-users (39.5 [11.3] vs 35.8 [10.8]). The total IAT score was associated with "adult entertainment" (OR=1.07, 95%CI: 1.06-1.08, P<0.001), "playing games" (OR=1.05, 95%CI: 1.04-1.06, P<0.001), "chatting" (OR=1.07, 95%CI: 1.06-1.08, P<0.001) and "discussion" (OR=1.08, 95%CI: 1.07-1.09, P<0.001) as reasons for Internet use. The IAT score had a significant negative correlation with social support (r=-0.24, P<0.001) and a significant positive correlation with the CAGE score (r=0.18, P<0.001). Using factor analysis, we found a single factor solution with a Cronbach's alpha of 0.92.

CONCLUSIONS

The IAT seems to provide a valid measurement of harmful use of the Internet, as the score was significantly associated with variables tapping psychopathology.

Association between markers of renal function and C-reactive protein level in the elderly: confounding by functional status

OBJECTIVE

To analyse the cross-sectional association between measures of renal function and inflammation in an elderly population and to evaluate the confounding effect of impaired physical functioning on these relationships.

MATERIAL AND METHODS

Cystatin C and creatinine were measured in serum samples from 1110 elderly subjects in a community-based cross-sectional survey (Lieto Study) in southwestern Finland. Glomerular filtration rate (GFR) was estimated by means of the Modification of Diet in Renal Disease (MDRD) equation. Associations between renal measures and sensitive C-reactive protein (CRP) and the impact of functional status were determined by multivariate linear models.

RESULTS

Based on standardized coefficients, cystatin C (beta 0.19; p<0.001) showed the strongest association with CRP compared to creatinine (beta 0.14; p<0.001) and estimated GFR (beta -0.13; p<0.001). Levels of CRP linearly increased across quintiles of cystatin C, whereas for creatinine and estimated GFR the increase was less graded. Impaired physical functioning was strongly associated with elevated levels of cystatin C (p<0.001) and CRP (p<0.001), but not with creatinine (p = 0.45) or estimated GFR (p = 0.38). For persons with impaired physical functioning, the odds ratio for belonging to the highest compared to the lowest cystatin C quintile was 7.04 (95% confidence interval 3.49-14.9; p<0.001), whereas for creatinine and estimated GFR this difference was not significant.

CONCLUSION

The weaker association observed between CRP and creatinine-based measures, as compared to cystatin C, reflects the misclassification of elderly frail subjects as having normal kidney function rather than suggests cystatin C itself to be a marker of inflammation.

Are Signs of Temporomandibular Disorders Stable and Predictable in Adolescents With Headache?

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample ( n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.