Preoperative Posterior Tilt Increases the Risk of Later Conversion to Arthroplasty After Osteosynthesis for Femoral Neck Fracture

BackgroundFemoral neck fractures (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty. The main aim of this study is to assess the risk factors associated with fixation failure leading to further arthroplasty in FNFs treated with cannulated screws.MethodsData on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle.ResultsAltogether 301 cases were included in the study. The overall reoperation rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P = .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P P = .2).ConclusionDisplaced fractures and fractures with a preoperative posterior tilt of 20° or Keywordsinternal fixationarthroplastyreoperationfixation failureposterior tiltfemoral neck fracture</div

Neuromuscular Performance and Hormonal Profile During Military Training and Subsequent Recovery Period

Introduction Military training loads may induce different physiological responses in garrison and field training and only a little is known about how short-time recovery, lasting a few days, affects neuromuscular fitness and hormonal profile. This study aimed to investigate the effects of garrison and field military service on neuromuscular performance and hormonal profile and to evaluate the effects of a 3-day recovery on those factors. Methods Twenty healthy male soldiers (20 ± 1 years) participated in the study, which consisted of 4 days of garrison training [days (D) 1–4] and 7 days of military field training (Days 5–12) followed by a 3-day recovery period (Day 15). Serum hormone concentrations [testosterone (TES), cortisol (COR), sex-hormone binding globulin (SHBG), free thyroxine (T4)] were assessed at D1, D5, D8–12, and D15. Handgrip strength was measured in 10 participants at D1, D5, D8, D12, and D15. Maximal isometric force, electromyography, and rate of force development (RFD) of the knee extensors and arm flexors were also measured at D5, D12, and D15. Results The maximal force of both the arm flexors and knee extensors was not affected by the garrison or field training, whereas the RFD of the knee extensors was decreased during the field training (D5: 383 ± 130 vs. D12: 321 ± 120 N/s, p < 0.05). In addition, handgrip strength was mostly no affected, although a significant difference was observed between D8 and D12 (531 ± 53 vs. 507 ± 43 N, p < 0.05) during the field training. TES decreased already during the garrison training (D1: 18.2 ± 3.9 vs. D5: 16.2 ± 4.0 nmol/L, p < 0.05) and decreased further during the field training compared to baseline (D8: 10.2 ± 3.6 - D11: 11.4 ± 5.4 nmol/L, p < 0.05) exceeding the lowest concentration in the end of the field training (D12: 7.1 ± 4.1 nmol/L, p < 0.05). Similar changes were observed in free TES (D1: 72.2 ± 31.4 vs. D12: 35.1 ± 21.5 nmol/L, p < 0.001). The TES concentration recovered back to the baseline level and free TES increased after the recovery period compared with the baseline values (D15: 19.9 ± 5.3 nmol/L, D15: 99.7 ± 41.1 nmol/L, respectively). No changes were observed in the COR or SHBG concentrations during the garrison period. COR was decreased in the end of the field training (D12: 388 ± 109 nmol/L) compared with baseline (D1: 536 ± 113 nmol/L) (p < 0.05–0.001) but recovered back to the baseline levels after the recovery period (D15: 495 ± 58 nmol/L), whereas SHBG linearly increased towards the end of the field training (p < 0.05–0.001). Conclusions The present findings demonstrate that neuromuscular performance can be relatively well maintained during short-term garrison and field training even when a clear decrease in hormonal profile is evident. In addition, hormonal responses during field training seem to be greater compared to garrison training, however, the recovery of 3-day in free-living conditions seems to be sufficient for hormonal recovery. Therefore, a short-term recovery period lasting few days after the military field training may be required to maintain operational readiness after the field training.peerReviewe

Effects of military basic training on VO2max, body composition, muscle strength and neural responses in conscripts of different aerobic condition

Study aim: The purpose of this study was to evaluate neuromuscular adaptations in conscripts with different fitness levels (VO2max) during 8 weeks of military basic training (BT)

Serum sex-hormone binding globulin and cortisol concentrations are associated with overreaching during strenuous military training

The purpose was (a) to study the effect of an 8-week Finnish military basic training period (BT) on physical fitness, body composition, mood state, and serum biochemical parameters among new conscripts; (b) to determine the incidence of overreaching (OR); and (c) to evaluate whether initial levels or training responses differ between OR and noOR subjects. Fifty-seven males (19.7 ± 0.3 years) were evaluated before and during BT. Overreaching subjects had to fulfill 3 of 5 criteria: decreased aerobic physical fitness (VO2max), increased rating of perceived exertion (RPE) in 45-minute submaximal test at 70% of VO2max or sick absence from these tests, increased somatic or emotional symptoms of OR, and high incidence of sick absence from daily service. VO2max improved during the first 4 weeks of BT. During the second half of BT, a stagnation of increase in VO2max was observed, basal serum sex hormone-binding globulin (SHBG) increased, and insulin-like growth factor-1 and cortisol decreased. Furthermore, submaximal exercise-induced increases in cortisol, maximum heart rate, and postexercise increase in blood lactate were blunted. Of 57 subjects, 33% were classified as OR. They had higher basal SHBG before and after 4 and 7 weeks of training and higher basal serum cortisol at the end of BT than noOR subjects. In addition, in contrast to noOR, OR subjects exhibited no increase in basal testosterone/cortisol ratio but a decrease in maximal La/RPE ratio during BT. As one-third of the conscripts were overreached, training after BT should involve recovery training to prevent overtraining syndrome from developing. The results confirm that serum SHBG, cortisol, and testosterone/cortisol and maximal La/RPE ratios could be useful tools to indicate whether training is too strenuous.peerReviewe

Clinical isolates of <it>Yersinia enterocolitica</it> Biotype 1A represent two phylogenetic lineages with differing pathogenicity-related properties

Abstract Background Y. enterocolitica biotype (BT) 1A strains are often isolated from human clinical samples but their contribution to disease has remained a controversial topic. Variation and the population structure among the clinical Y. enterocolitica BT 1A isolates have been poorly characterized. We used multi-locus sequence typing (MLST), 16S rRNA gene sequencing, PCR for ystA and ystB, lipopolysaccharide analysis, phage typing, human serum complement killing assay and analysis of the symptoms of the patients to characterize 298 clinical Y. enterocolitica BT 1A isolates in order to evaluate their relatedness and pathogenic potential. Results A subset of 71 BT 1A strains, selected based on their varying LPS patterns, were subjected to detailed genetic analyses. The MLST on seven house-keeping genes (adk, argA, aroA, glnA, gyrB, thrA, trpE) conducted on 43 of the strains discriminated them into 39 MLST-types. By Bayesian analysis of the population structure (BAPS) the strains clustered conclusively into two distinct lineages, i.e. Genetic groups 1 and 2. The strains of Genetic group 1 were more closely related (97% similarity) to the pathogenic bio/serotype 4/O:3 strains than Genetic group 2 strains (95% similarity). Further comparison of the 16S rRNA genes of the BT 1A strains indicated that altogether 17 of the 71 strains belong to Genetic group 2. On the 16S rRNA analysis, these 17 strains were only 98% similar to the previously identified subspecies of Y. enterocolitica. The strains of Genetic group 2 were uniform in their pathogenecity-related properties: they lacked the ystB gene, belonged to the same LPS subtype or were of rough type, were all resistant to the five tested yersiniophages, were largely resistant to serum complement and did not ferment fucose. The 54 strains in Genetic group 1 showed much more variation in these properties. The most commonly detected LPS types were similar to the LPS types of reference strains with serotypes O:6,30 and O:6,31 (37%), O:7,8 (19%) and O:5 (15%). Conclusions The results of the present study strengthen the assertion that strains classified as Y. enterocolitica BT 1A represent more than one subspecies. Especially the BT 1A strains in our Genetic group 2 commonly showed resistance to human serum complement killing, which may indicate pathogenic potential for these strains. However, their virulence mechanisms remain unknown.</p