An operative approach to address severe genu valgum deformity in the Ellis-van Creveld syndrome

BACKGROUND: The genu valgum deformity seen in the Ellis-van Creveld syndrome is one of the most severe angular deformities seen in any orthopaedic condition. It is likely a combination of a primary genetic-based dysplasia of the lateral portion of the tibial plateau combined with severe soft-tissue contractures that tether the tibia into valgus deformations. Progressive weight-bearing induces changes, accumulating with growth, acting on the initially distorted and valgus-angulated proximal tibia, worsening the deformity with skeletal maturation. The purpose of this study is to present a relatively large case series of a very rare condition that describes a surgical technique to correct the severe valgus deformity in the Ellis-van Creveld syndrome by combining extensive soft-tissue release with bony realignment. METHODS: 1. Complete proximal to distal surgical decompression of the peroneal nerve. 2. Radical release and mobilization of the severe quadriceps contracture and iliotibial band contracture. 3. Distal lateral hamstring lengthening/tenotomy and lateral collateral ligament release. 4. Proximal and distal realignment of the subluxed/dislocated patella, medial and lateral retinacular release, vastus medialis advancement, patellar chondroplasty, medial patellofemoral ligament plication, and distal patellar realignment by Roux-Goldthwait technique or patellar tendon transfer with tibial tubercle relocation. 5. Proximal tibial varus osteotomy with partial fibulectomy and anterior compartment release. 6. Occasionally, distal femoral osteotomy. RESULTS: In all cases, the combination of radical soft-tissue release, patellar realignment and bony osteotomy resulted in 10° or less of genu valgum at the time of surgical correction. Complications of surgery included three patients (five limbs) with knee stiffness that was successfully manipulated, one peroneal nerve palsy, one wound slough and hematoma requiring a skin graft, and one pseudoarthrosis requiring removal of hardware and repeat fixation. At last follow-up, radiographic correction of no more than 20° of genu valgum was maintained in all but four patients (four limbs). Two patients (three limbs) had or currently require revision surgery due to recurrence of the deformity. CONCLUSION: The operative approach presented in this study has resulted in correction of the severe genu valgum deformity in Ellis-van Creveld syndrome to 10° or less of genu valgum at the time of surgery. Although not an outcomes study, a correction of no more than 20° genu valgum has been maintained in many of the cases included in the study. Further clinical follow-up is still warranted. LEVEL OF EVIDENCE: IV

Phylogeny of the Australian Solanum dioicum group using seven nuclear genes: Testing Symon’s fruit and seed dispersal hypotheses.

The dioecious and andromonoecious Solanum taxa (the “S. dioicum group”) of the Australian Monsoon Tropics have been the subject of phylogenetic and taxonomic study for decades, yet much of their basic biology is still unknown. This is especially true for plant-animal interactions, including the influence of fruit form and calyx morphology on seed dispersal. We combine field/greenhouse observations and specimen-based study with phylogenetic analysis of seven nuclear regions obtained via a microfluidic PCR-based enrichment strategy and high-throughput sequencing, and present the first species-tree hypothesis for the S. dioicum group. Our results suggest that epizoochorous trample burr seed dispersal (strongly linked to calyx accrescence) is far more common among Australian Solanum than previously thought and support the hypothesis that the combination of large fleshy fruits and endozoochorous dispersal represents a reversal in this study group. The general lack of direct evidence related to biotic dispersal (epizoochorous or endozoochorous) may be a function of declines and/or extinctions of vertebrate dispersers. Because of this, some taxa might now rely on secondary dispersal mechanisms (e.g. shakers, tumbleweeds, rafting) as a means to maintain current populations and establish new ones

Alzheimer’s disease susceptibility gene apolipoprotein e (APOE) and blood biomarkers in UK Biobank (N=395,769)

Background: Alzheimer’s disease (AD) is a neurodegenerative condition where the underlying etiology is still unclear. Investigating the potential influence of apolipoprotein E (APOE), a major genetic risk factor, on common blood biomarkers could provide a greater understanding of the mechanisms of AD and dementia risk. Objective: Our objective was to conduct the largest (to date) single-protocol investigation of blood biomarkers in the context of APOE genotype, in UK Biobank. Methods:After quality control and exclusions, data on 395,769 participants of White European ancestry were available for analysis. Linear regressions were used to test potential associations between APOE genotypes and biomarkers. Results: Several biomarkers significantly associated with APOE ɛ4 ‘risk’ and ɛ2 ‘protective’ genotypes (versus neutral ɛ3/ɛ3). Most associations supported previous data: for example, ɛ4 genotype was associated with elevated low-density lipoprotein cholesterol (LDL) (standardized beta [b] = 0.150 standard deviations [SDs] per allele, p < 0.001) and ɛ2 with lower LDL (b = –0.456 SDs, p < 0.001). There were however instances of associations found in unexpected directions: e.g., ɛ4 and increased insulin-like growth factor (IGF-1) (b = 0.017, p < 0.001) where lower levels have been previously suggested as an AD risk factor. Conclusion: These findings highlight biomarker differences in non-demented people at genetic risk for dementia. The evidence herein supports previous hypotheses of involvement from cardiometabolic and neuroinflammatory pathways

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Phylogeny of the Australian Solanum dioicum group using seven nuclear genes, with consideration of Symon's fruit and seed dispersal hypotheses.

The dioecious and andromonoecious Solanum taxa (the "S. dioicum group") of the Australian Monsoon Tropics have been the subject of phylogenetic and taxonomic study for decades, yet much of their basic biology is still unknown. This is especially true for plant-animal interactions, including the influence of fruit form and calyx morphology on seed dispersal. We combine field/greenhouse observations and specimen-based study with phylogenetic analysis of seven nuclear regions obtained via a microfluidic PCR-based enrichment strategy and high-throughput sequencing, and present the first species-tree hypothesis for the S. dioicum group. Our results suggest that epizoochorous trample burr seed dispersal (strongly linked to calyx accrescence) is far more common among Australian Solanum than previously thought and support the hypothesis that the combination of large fleshy fruits and endozoochorous dispersal represents a reversal in this study group. The general lack of direct evidence related to biotic dispersal (epizoochorous or endozoochorous) may be a function of declines and/or extinctions of vertebrate dispersers. Because of this, some taxa might now rely on secondary dispersal mechanisms (e.g. shakers, tumbleweeds, rafting) as a means to maintain current populations and establish new ones

Phylogeny of the Australian Solanum dioicum Group Using Seven Nuclear Genes: Testing Symon’s Fruit and Seed Dispersal Hypotheses

The dioecious and andromonoecious Solanum taxa (previously described as the “S. dioicum group”) of the Australian Monsoon Tropics have been the subject of phylogenetic and taxonomic study for decades, yet much of their basic biology is still unknown. This is especially true for plant-animal interactions, including the influence of fruit form and calyx morphology on seed dispersal. We combine field/greenhouse observations and specimen-based study with phylogenetic analysis of seven nuclear regions obtained via a microfluidic PCR-based enrichment strategy and high-throughput sequencing, and present the first intron-containing nuclear gene dataset in the genus Solanum and the first species-tree hypothesis for the S. dioicum group. Our results suggest that epizoochorous trample burr seed dispersal (strongly linked to calyx accrescence) is far more common among Australian Solanum than previously thought and support the hypothesis that the combination of large fleshy fruits and endozoochorous dispersal represents a reversal in this study group. The general lack of direct evidence related to biotic dispersal (epizoochorous or endozoochorous) may be a function of declines and/or extinctions of vertebrate dispersers. Because of this, some taxa might now rely on secondary dispersal mechanisms (e.g. shakers, tumbleweeds, rafting) as a means to maintain current populations and establish new ones

Päivittäisasioinnin palveluketju Case Nooa Säästöpankki Oy

Tein opinnäytetyöni toimeksiantona Nooa Säästöpankki Oy:lle. Työn tavoitteena oli tutkia päivittäisasioinnin palveluketjua. Tarkoituksena oli tuottaa Nooa Säästöpankille henkilöasiakkaan päivittäisasioinnin palveluketjun kuvaus, keskittyen tarkkojen tuote- ja järjestelmäkuvausten sijasta enemmänkin Nooan toimintatapaan, myyntiin ja myyntiprosessiin sekä käytännön vinkkeihin. Kilpailutilanne pankkialalla, kuten muillakin toimialoilla, on kiristynyt. Perinteinen pankkius-kollisuus on muisto vain, ja asiakas saattaa vaihtaa pankkia heti kun saa paremman tarjouksen muualta. Jatkuvasti kiristyvässä kilpailutilanteessa taistelu asiakkaista on kovaa. Sekä asiak-kuuksien saaminen että säilyttäminen on haasteellista. Yksi parhaista tavoista erottua kilpailijoista, on kokonaisvaltainen palvelu. Mitä paremmin asiakasta palvellaan ja mitä laajemmin asiakkaan tarpeet otetaan huomioon ja pyritään ratkaisemaan, sitä korkeampi on asiakkaan kynnys lähteä kilpailuttamaan palveluitaan. Tasaisen korkealaatuinen myyntiprosessi on avain asiakastyytyväisyyteen. Se edellyttää, että jokainen yrityksen työntekijä tuntee yhteiset toimintatavat ja noudattaa niitä. Päivittäisasioinnin prosessi voidaan nähdä yhtenä Nooa Säästöpankin tärkeimpänä prosessina. Päivittäisasioinnin palveluissa toimivat henkilöt ovat yrityksen näkyvin osa ja antavat kasvot yritykselle. Siksi onkin tärkeää, että jokainen päivittäispalveluissa toimiva myyjä, etenkin uusi työntekijä, ymmärtää niin roolinsa pankin kasvoina kuin myös mahdollisuutensa havaita asiakkaan tarpeet ensimmäisenä ja jopa ainoana. Pankin päivittäispalveluissa toimivat henkilöt tapaavat päivässä ylivoimaisesti eniten asiakkaita, ja tämä tosiasia on osattava pankissa hyödyntää. Tutkimus toteutettiin kvalitatiivisena eli laadullisena tutkimuksena. Tutkimusmenetelmäksi valittiin tapaustutkimus koska tutkimuksen kohteena on yksi yksittäinen tapaus, prosessi. Aineisto kerättiin erilaisia kirjallisia ja virtuaalisia dokumentteja tutkien, sekä havainnoimalla. Tutkittava kohde on ainutlaatuinen, ja siitä on vaikea saada syvällistä tietoa muulla tavoin kuin havainnoimalla. Opinnäytetyön tekijä itse on työskennellyt yrityksessä vuodesta 2009 ja päässyt näin ollen tekemään lukuisia havaintoja prosessin kulusta. Nämä havainnot toimivat tärkeänä aineistona tutkimusta tehdessä. Tutkimuksen tuloksena saatu päivittäisasioinnin palveluketjun kuvaus tukee päivittäisasioinnin palveluissa toimivaa henkilöä myynnillisen toimintatavan omaksumisessa. Uskon työstä olevan hyötyä sekä yritykselle sekä loppukäyttäjälle. Työn tuloksia ei suoraan pystytä käyttämään hyväksi muualla, mutta soveltaen siitä voi olla hyötyä myös muille pankeille.The service chain in day-to-day banking – Case Nooa Savings Bank Ltd This thesis was made as an assignment for Nooa Savings Bank. The purpose of this thesis was to investigate the service chain in day-to-day banking for private customers and to produce a description of the process for Nooa Savings Bank. The main focus was on the course of action, the selling process and practical suggestions for improvement rather than just focusing on exact product and system descriptions. Competition in the banking sector is fiercer than ever, and traditional customer loyalty has greatly diminished. Customers are more likely to switch bank if they get a better offer elsewhere, and banks must struggle to acquire new customers as well as retain old ones. The best way to stand out from the competition is to offer a comprehensive service. The better the bank serves its customers and provides solutions to their individual needs the more unlikely it becomes that they might switch to another bank. A fair and high quality selling process is the key to customer satisfaction. This requires that every employee in the company is aware of the goals of the organization and is able to act in accordance with them. The service chain in day-to-day banking can be seen as one of the most important processes in Nooa Savings Bank. The employees involved in the process play a key role and by virtue of their position at the customer interface constitute the face of the company. For this reason it is extremely important that every salesman working in day-to-day banking services and especially new employees understand their roles as the face of the bank as well as their opportunity to be the first and possibly the only one to observe the needs of the customer. These employees meet the overwhelming majority of customers and this is a fact that the bank has to use to its advantage. The research was conducted using a qualitative research method with the case study as chosen research method because the object of the study was a single case and one process. Data was gathered by studying written and virtual documents and by observation. The object of the study is unique and it would be difficult to get significant information in any other way than by observing. The author of the thesis herself has worked at Nooa Savings Bank since 2009 and therefore has been able to make several observations of the course of the process. These observations can be considered as valuable data in this research. The description of the service chain in day-to-day banking which was produced as result of the research can help the new employee to absorb the sales oriented procedures more rapidly. I believe that the results of the thesis will be useful for Nooa Savings Bank as well as for the end user. The results can not directly be taken advantage of by others but indirectly they can be useful for other banks

Hydroxychloroquine and tocilizumab therapy in COVID-19 patients—An observational study

Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80–1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83–1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75–1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57–1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials