Degenerative cervical spine changes among early career fighter pilots : a 5-year follow-up

Introduction Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls. Methods At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group). Both groups underwent MRI of the cervical spine at the baseline and after 5 years. Degenerative changes evaluated using MRI included intervertebral disc (IVD) degeneration (Pfirrmann classification), disc herniations, uncovertebral arthrosis, Schmorl’s nodes, Modic changes, spinal canal stenosis, kyphosis and scoliosis. Results The degree of IVD degeneration in the whole cervical spine increased significantly in both populations with no between-group differences. The prevalence of disc herniations also tended to increase in both populations with no difference in the incidence over the follow-up. However, pilots proved to have more disc herniations at the baseline and at the follow-up. There were virtually no between-group differences in other assessed degenerative changes. Discussion We found that IVD degeneration and the prevalence of disc herniations increased at a similar rate for fighter pilots and non-flying military students when all cervical levels were summed up. The lack of difference may be explained by the relatively low cumulative +Gz exposure during the first 5 years of a pilots’ career

Viides- ja kuudesluokkalaisten oppilaiden käsityksiä, merkityksiä ja mieltymyksiä opettajien valintaan vaikuttavista tekijöistä

Tiivistelmä. Suomessa ammatti- ja alakohtainen segregaatio on erittäin voimakasta. Kasvatus- ja opetusala on naisvaltainen. Esimerkiksi Opetushallitus (2017) on esittänyt huolensa liittyen alan naisvaltaisuuteen ja sen mahdollisesta vaikutuksesta oppilaisiin. Tutkielma lähestyy aihetta toisesta näkökulmasta kysyen oppilailta itseltään, onko opettajan sukupuolella todella merkitystä heille jollain tapaa vai kokevatko oppilaat opettajan muut piirteet tärkeämmiksi. Tutkielmassa pyrittiin etsimään vastauksia kolmeen tutkimuskysymykseen: Mitkä tekijät ohjasivat eniten oppilaiden tekemiä opettajavalintoja, millä tavoin oppilaat perustelivat tekemäänsä opettajavalintaa, ja oliko tyttöjen ja poikien tekemien valintojen ja perustelujen välillä löydettävissä eroja ja yhtäläisyyksiä? Tutkielma toteutettiin kvalitatiivisena tutkimuksena, fenomenografiseen tutkimusmetodologiaan nojautuen. Tutkielman taustalla vaikuttaa myös fenomenologinen tieteenfilosofia. Tutkielman aineisto kerättiin juuri tätä tutkielmaa varten kehitetyllä menetelmällä, jossa oppilaat valitsivat mielestään mieluisimman opettajan itselleen neljästä, tutkijoiden luomasta opettajaprofiilista. Oppilaiden tuli perustella valintansa kirjallisesti. Näin voitiin tutkia, mitä piirteitä oppilaat arvottivat kaikkein eniten valitsemassaan opettajassa. Tutkimusaineistoon sovellettiin sisällönanalyysiä sekä merkitysanalyysiä. Tärkeimmiksi oppilaiden valintaa ohjanneiksi tekijöiksi nousivat opettajan persoonaan liittyvät tekijät, kuten esimerkiksi opettajan harrastukset. Oppilaat perustelivat useimmiten opettajan valintaa samaistumisen kautta, mutta myös opettajasta syntyneen mielikuvan pohjalta. Oppilaat painottivat myös opettajan työkokemusta valinnan perusteluissaan. Iältään opettajan toivottiin olevan sopivan nuori, muttei liian vanhakaan. Opettajan sukupuolella ei näyttänyt olevan oppilaille kovin suurta merkitystä. Koko aineiston tasolla nais- ja miesopettajat tulivat valituiksi yhtä monta kertaa. Vastaajien sukupuolta tarkastellessa merkittäviä linjaeroja ei sukupuolten väliltä löytynyt, vaan oppilaat korostivat perusteluissaan kutakuinkin samoja tekijöitä sukupuolestaan riippumatta. Voidaan todeta, että muut opettajaan liittyvät asiat ja piirteet näyttäytyvät oppilaille merkityksellisempinä kuin opettajan sukupuoli

In vitro cytotoxicity and surface topography evaluation of additive manufacturing titanium implant materials

Custom-designed patient-specific implants and reconstruction plates are to date commonly manufactured using two different additive manufacturing (AM) technologies: direct metal laser sintering (DMLS) and electron beam melting (EBM). The purpose of this investigation was to characterize the surface structure and to assess the cytotoxicity of titanium alloys processed using DMLS and EBM technologies as the existing information on these issues is scarce. "Processed" and "polished" DMLS and EBM disks were assessed. Microscopic examination revealed titanium alloy particles and surface flaws on the processed materials. These surface flaws were subsequently removed by polishing. Surface roughness of EBM processed titanium was higher than that of DMLS processed. The cytotoxicity results of the DMLS and EBM discs were compared with a "gold standard" commercially available titanium mandible reconstruction plate. The mean cell viability for all discs was 82.6% (range, 77.4 to 89.7) and 83.3% for the control reconstruction plate. The DMLS and EBM manufactured titanium plates were non-cytotoxic both in "processed" and in "polished" forms.Peer reviewe

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

<p>Abstract</p> <p>Background</p> <p>Bowel symptoms are often considered an indication to perform colonoscopy to identify or rule out colorectal cancer or precancerous polyps. Investigation of bowel symptoms for this purpose is recommended by numerous clinical guidelines. However, the evidence for this practice is unclear. The objective of this study is to systematically review the evidence about the association between bowel symptoms and colorectal cancer or polyps.</p> <p>Methods</p> <p>We searched the literature extensively up to December 2008, using MEDLINE and EMBASE and following references. For inclusion in the review, papers from cross sectional, case control and cohort studies had to provide a 2×2 table of symptoms by diagnosis (colorectal cancer or polyps) or sufficient data from which that table could be constructed. The search procedure, quality appraisal, and data extraction was done twice, with disagreements resolved with another reviewer. Summary ROC analysis was used to assess the diagnostic performance of symptoms to detect colorectal cancer and polyps.</p> <p>Results</p> <p>Colorectal cancer was associated with rectal bleeding (AUC 0.66; LR+ 1.9; LR- 0.7) and weight loss (AUC 0.67, LR+ 2.5, LR- 0.9). Neither of these symptoms was associated with the presence of polyps. There was no significant association of colorectal cancer or polyps with change in bowel habit, constipation, diarrhoea or abdominal pain. Neither the clinical setting (primary or specialist care) nor study type was associated with accuracy.</p> <p>Most studies had methodological flaws. There was no consistency in the way symptoms were elicited or interpreted in the studies.</p> <p>Conclusions</p> <p>Current evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. Bodies preparing guidelines for clinicians and consumers to improve early detection of colorectal cancer need to take into account the limited value of symptoms.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Evaluation of the frequency of HLA determinants in patients with gingival overgrowth induced by cyclosporine-A

This study has been designed to investigate the immunogenetic susceptibility of Cyclosporine-A (CsA) immunosuppressed renal transplant patients to development of gingival overgrowth, and the amplifying effect of calcium channel blockers on the severity of this clinical entity. 52 renal transplant recipients were selected and initially grouped as follows: group (Gp)1: CsA (n=7); Gp 2: CsA+verapamil (n=26); Gp 3: CsA+diltiazem (n=6); Gp 4: CsA+nifedipine (n=13). These groups were not found to be significantly different in age, sex, plaque index (PII), gingival index (GI), calculus index, periodontal probing depth, serum CsA level, or duration of CsA therapy (p>0.05). No significant (p>0.05) additive effect of the calcium channel blockers on the gingival overgrowth (GO) was assessed. The main group (n=52) was evaluated for the correlations between the clinical and the pharmacological variables and the GO. GI (rs=0.60) and the periodontal probing depth (rs=0.71) were found to be moderately correlated with the GO. The patients were regrouped based on the severity of overgrowth and recognized as responders (n=26) and nonresponders (n=26). Age, sex, calculus index, serum CsA level, duration of the CsA therapy, were not statistically different among these groups (p>0.05). P1I, GI, periodontal probing depth, and GO were significantly higher in the responder group (p>0.05). Analysis of HLA distribution of the responders and the nonresponders and comparison with the controls (n=3731) revealed that a statistically significant (p<0.001) % of the nonresponders were positive for HLA-DR1. These data would indicate that an immunogenetic predisposition should be suspected in the pathogenesis of the entity, and that HLA-DE 1 would have a protective role against gingival overgrowth induced by CsA