Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Paratiisi : Opinnäytetyönä oma cd-levy

Opinnäytetyönä tehtiin Paratiisi-niminen CD-levy, joka sisältää perinteistä tanssimusiikkia. Levyllä on kolme soolo-kappaletta harmonikalla ja kolme kappaletta bändin kanssa soitettuna. Kappaleiden alkuperäinen tulkinta on pyritty säilyttämään mahdollisimman hyvin. CD:stä on tarkoitus painattaa lisää levyjä ja myydä niitä keikoilla käyntikorttei-na. Opinnäytetyöhön sisältyi kokonaisuuden suunnittelu, kappaleiden harjoittelua ja tuottajana toimimista. Opinnäytetyön raportissa on kerrottu lyhyesti Suomen iskelmämusiikin historiasta. Kirjallisessa osuudessa kerrotaan myös työn etenemisestä eli suunnittelemisesta, kappalevalinnoista, kappaleiden harjoittelemisesta, äänittämisestä ja levyn miksaamisesta. Lopuksi on päätäntäluku, jossa kerrotaan työn onnistumisesta ja siitä, mitä olisi voinut pro-duktion aikana tehdä toisin.The goal of the thesis was to make a CD-record called Paratiisi (Paradise). The CD included three solo accordion pieces and three pieces played with a band. The goal was to preserve as much of the original interpretation as pos-sible. There is an intention to print more records of the album and sell them at gigs as business cards. Thesis in-cluded planning, rehearsing pieces, and acting as a producer. The written part of the thesis includes a brief overview of the history of Finnish popular music. The working process is also included in the written part of the thesis which includes: the design, the song choices, practicing, recording and mixing. Finally there is a conclusion, a discussion about the success of the work and what could have been done differently

The clinical course of patients with preschool manifestation of Type 1 diabetes is independent of the HLA DR-DQ genotype

Introduction: Major histocompatibility complex class II genes are considered major genetic risk factors for autoimmune diabetes. We analysed Human Leukocyte Antigen (HLA) DR and DQ haplotypes in a cohort with early-onset (age 0.05). Residual C-peptide was detectable in 23.5% and C-peptide levels in the highest-risk group were comparable to levels in moderate to high risk genotypes. Conclusion: In this study, we saw no evidence for a different clinical course of early-onset T1D based on the HLA genotype within the first ten years after manifestation

Lipoprotein‐associated phospholipase A2 activity in obese adolescents with and without type 2 diabetes

Seyfarth J, Reinehr T, Hoyer A, et al. Lipoprotein‐associated phospholipase A2 activity in obese adolescents with and without type 2 diabetes. Journal of Inherited Metabolic Disease. 2018;41(1):73-79.**Abstract** Lipoprotein‐associated phospholipase A2 (Lp‐PLA2) was identified as a strong predictor for cardiovascular events. Furthermore, it is highly associated with obesity. The role of Lp‐PLA2 in diabetes mellitus is controversial and analyses, especially in adolescents with type 2 diabetes (T2D), are missing. Therefore, we compared Lp‐PLA2 activity between two obese age‐, sex‐, and BMI‐matched cohorts of adolescents with and without T2D. Relationships between Lp‐PLA2 activity and age, BMI, hemoglobin A1c, lipids, and adipokines were evaluated. Lp‐PLA2 activity was analyzed in serum of 72 obese adolescents without T2D (mean age 15.2 ± 1.6 years) and in 65 obese adolescents with T2D (mean age 15.5 ± 1.8 years). Clinical data were obtained from the Diabetes‐Patienten‐Verlaufsdokumentation (DPV) registry. Surprisingly, obese adolescents with T2D had lower levels of Lp‐PLA2 activity than obese children without T2D (160.2 ± 45.0 versus 180.9 ± 35.6 nmol/min/ml,p= 0.003), but this decrease could only be detected in male (158.8 ± 45.3 versus 190.8 ± 31.3 nmol/min/ml,pp= 0.60). In multiple linear regression analysis, differences in Lp‐PLA2 activity between cohorts remained large and significant (ß‐coefficient: −31.60, 95% confidence interval [−49.27;−13.93],pp= 0.004) and negatively associated with the adipokines leptin (ß‐coefficient: −0.53 [−0.89;−0.17], p = 0.004) and adiponectin (ß‐coefficient: −3.06, [−5.63;−0.48],p= 0.02). Elevated mean glucose concentrations in adolescents with T2D were not associated with an increase but with a decrease of Lp‐PLA2 activity. Hence, in young patients with T2D the Lp‐PLA2 activity as a risk predictor for cardiovascular events needs further investigation

Time to Peak Glucose and Peak C-Peptide During the Progression to Type 1 Diabetes in the Diabetes Prevention Trial and TrialNet Cohorts

OBJECTIVE To assess the progression of type 1 diabetes using time to peak glucose or C-peptide during oral glucose tolerance tests (OGTTs) in autoantibody-positive relatives of people with type 1 diabetes. RESEARCH DESIGN AND METHODS We examined 2-h OGTTs of participants in the Diabetes Prevention Trial Type 1 (DPT-1) and TrialNet Pathway to Prevention (PTP) studies. We included 706 DPT-1 participants (mean ± SD age, 13.84 ± 9.53 years; BMI Z-score, 0.33 ± 1.07; 56.1% male) and 3,720 PTP participants (age, 16.01 ± 12.33 years; BMI Z-score, 0.66 ± 1.3; 49.7% male). Log-rank testing and Cox regression analyses with adjustments (age, sex, race, BMI Z-score, HOMA-insulin resistance, and peak glucose/C-peptide levels, respectively) were performed. RESULTS In each of DPT-1 and PTP, higher 5-year diabetes progression risk was seen in those with time to peak glucose >30 min and time to peak C-peptide >60 min (P < 0.001 for all groups), before and after adjustments. In models examining strength of association with diabetes development, associations were greater for time to peak C-peptide versus peak C-peptide value (DPT-1: χ2 = 25.76 vs. χ2 = 8.62; PTP: χ2 = 149.19 vs. χ2 = 79.98; all P < 0.001). Changes in the percentage of individuals with delayed glucose and/or C-peptide peaks were noted over time. CONCLUSIONS In two independent at-risk populations, we show that those with delayed OGTT peak times for glucose or C-peptide are at higher risk of diabetes development within 5 years, independent of peak levels. Moreover, time to peak C-peptide appears more predictive than the peak level, suggesting its potential use as a specific biomarker for diabetes progression

Early probiotic supplementation and the risk of celiac disease in children at genetic risk

Abstract Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk