Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows

Purpose The objectives of this study were to evaluate the results in the outpatient treatment of recalcitrant lateral epicondylitis with release of the common extensor origin according to Hohmann and to determine any prognostic factors. Methods Eighty tennis elbows in 77 patients with a characteristic history of activity-related pain at the lateral epicondyle interfering with the activities of daily living refractory to conservative care for at least 6 months and a confirmatory physical examination were included. Clinical outcome was evaluated using the QuickDASH score system. Data were collected before the operation and at the medians of 18 months (range 6–36 months; short term) and 4 years (range 3–6 years; medium term) postoperatively. Results The mean QuickDASH was improved both at the short- and the medium-term follow-ups and did not change significantly between the follow-ups. At the final followup, the QuickDASH was improved in 78 out of 80 elbows and 81% was rated as excellent or good (QuickDASH\40 points). We found a weak correlation between residual symptoms (a high QuickDASH score) at the final follow-up and high level of baseline symptoms (r = 0.388), acute occurrence of symptoms (r = 0.362), long duration of symptoms (r = 0.276), female gender (r = 0.269) and young age (r = 0.203), whereas occurrence in dominant arm, a work-related cause or strenuous work did not correlate significantly with the outcome. Conclusion Open lateral extensor release performed as outpatient surgery results in improved clinical outcome at both short- and medium-term follow-ups with few complications. High baseline disability, sudden occurrence of symptoms, long duration of symptoms, female gender and young age were found to be weak predictors of poor outcome

Fishing, reproductive volume and regulation: population dynamics and exploitation of the eastern Baltic cod

The relative importance of exploitation rate and environmental variability in generating fluctuations of harvested populations is a key issue in academic ecology as well as population management. We studied how the eastern Baltic cod (Gadus morhua) is affected by fishing and environmental variation by using a newly developed single species state-space model. Survey data and auxiliary environmental data were used to estimate the model parameters. The model was then used to predict future development of the eastern Baltic cod under different fishing mortalities and abiotic conditions. Abiotic condition was represented by an index: reproductive volume which is the volume of water suitable (in terms of salinity and oxygen content) for the successful development of the early life stages of Baltic cod. The model included direct density dependence, fishing, and a lagged effect of reproductive volume. Our analysis showed that fishing rate is approximately three times more important than reproductive volume in explaining the population dynamics. Furthermore, our model suggests either under- or over-compensatory dynamics depending on the reproductive volume and long term catch levels. It follows that fishing can either reduce or increase temporal oscillations of the cod stock depending on whether the dynamics is over- or undercompensatory, respectively. The sustainable level of fishing rate is however dependent on reproductive volume. Our model predicts a dual role of fishing rate, stabilizing when reproductive volume is high and destabilizing when it is low. Exploitation rate may therefore increase or decrease the risk of the population of cod dropping below a given biomass reference point depending on the environmental conditions, which has practical implications for fisheries management

Indices of Cholesterol Metabolism and Relative Responsiveness to Ezetimibe and Simvastatin

Context: The level and duration of exposure to circulating low-density lipoprotein-cholesterol (LDL-C) are major contributors to coronary atherosclerosis. Therefore, optimal prevention will require long-term LDL-C reduction, making it important to select the most effective agent for each individual