Failed meniscal repairs after anterior cruciate ligament reconstruction increases risk of revision surgery

Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced quality of life because of recurrent episodes of instability, restrictions in level of activity, and development of osteoarthritis. A profound knowledge of the causes of a failed surgery can ultimately help improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to revision surgery after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: From a prospective cohort of primary ACLRs performed at a single center, patients who required later revision surgery were matched with a control group of uneventful primary ACLRs. Patient characteristics, data from the preoperative examinations, KT-1000 arthrometer laxity testing, Tegner activity scale, International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score, and perioperative data from the initial surgery were included. Results: A total of 100 revision cases and 100 matched controls, with a median follow-up time of 11 years, were included in the study. Those who had undergone revision surgery were younger at the time of reconstruction and had a shorter time from injury to surgery than their matched controls (P = .006). The control group—of uneventful ACLRs—had a higher incidence of meniscal repair at reconstruction (P = .024). Also, the revision group more frequently experienced later failure of the previous meniscal repair (P = .004). Surgeon experience was not found to affect the risk of revision ACL surgery. Those who had undergone ACL revision surgery had more frequently received a hamstring tendon graft size of <8 mm (P = .018) compared with the controls. Conclusion: The current study demonstrated that failed meniscal repair and a hamstring tendon graft size of <8 mm were associated with primary ACLR failure. Also, younger age at the time of surgery and shorter time from injury to surgery were found to affect the risk of undergoing revision ACL surgery.publishedVersio

Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction

Background: The Segond fracture is an avulsion of the anterolateral tibia that can be found in patients with an anterior cruciate ligament (ACL) tear. It is currently unclear if the Segond fracture needs treatment or if it heals spontaneously and if it is associated with an increased risk of failure after ACL reconstruction. Purpose: To identify the incidence and spontaneous healing rate of Segond fractures in a consecutive cohort of patients undergoing ACL reconstruction and to examine the predictive value of the Segond fracture on the risk of undergoing revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a cohort undergoing isolated ACL reconstruction between 2002 and 2016 was performed. Radiographs from the time of injury and preoperative radiographs were evaluated for Segond fractures and healed Segond fractures. Descriptive data were extracted from an internal quality database. Statistical analyses were performed to investigate risk of revision surgery and to compare across subgroups of patients. Results: A total of 1364 patients were included in the study. The incidence of Segond fractures was 7.4%. In addition, 10.4% of patients displayed signs of healed Segond fractures. In total, 15.2% of patients had either 1 or both findings. The overall healing response of the fracture was 35.6%. Those with Segond fractures were older (P = .014) and had a shorter interval from injury to surgery (P = .003) as compared with the rest of the cohort. The incidence of Segond fractures was significantly higher in those injured during downhill skiing as compared with other injury mechanisms (P = .04). The Segond fracture did not represent an increased risk of undergoing revision when compared with the control group (not significant). Conclusion: The incidence of conventional Segond fractures in patients with ACL injury was found to be in accordance with former studies. Accounting for the high incidence of healed Segond fractures, a much higher incidence (15%) was seen. Although the spontaneous healing rate from initial radiographs to preoperative imaging was only 36%, the presence of Segond fractures did not represent a higher risk of undergoing revision surgery.publishedVersio

The Effect of Posterior Tibial Slope on the Risk of Revision Surgery After Anterior Cruciate Ligament Reconstruction

Background: A significant proportion of patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) later experience graft failure. Some studies suggest an association between a steep posterior tibial slope (PTS) and graft failure. Purpose: To examine the PTS in a large cohort of patients about to undergo ACLR and to determine whether a steep PTS is associated with later revision surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review of a cohort undergoing isolated ACLR between 2002 and 2012 (with 8-19 years of follow-up) was conducted. Preoperative sagittal radiographs of knees in full extension were used for measurements of the PTS. There were 2 independent examiners who performed repeated measurements to assess the reliability of the method. Statistical analyses were performed to compare the PTS in the groups with and without later revision surgery. Results: A total of 728 patients, with a mean age of 28 years at the time of surgery, were included. Overall, 10% (n = 76) underwent revision surgery during the observation period. The group of injured knees had a significantly steeper PTS compared with the group of uninjured knees (9.5° vs 8.7°, respectively; P < .05). The mean PTS in the no revision group was 9.5° compared with 9.3° in the revision group (not significant). Dichotomized testing of revision rates related to PTS cutoff values of ≥10°, ≥12°, ≥14°, ≥16°, and ≥18° showed no association of PTS steepness (not significant) to graft failure. Patients with revision were younger than the ones without (mean age, 24 ± 8 vs 29 ± 10 years, respectively) and had a shorter time from injury to ACLR (mean, 14 ± 27 vs 24 ± 44 months, respectively) as well as a smaller graft size (8.2 vs 8.4 mm, respectively; P = .040). Conclusion: The current study did not find any association between a steep PTS measured on lateral knee radiographs and revision ACL surgery. However, a steeper PTS was seen in the group of injured knees compared with the group of uninjured (contralateral) knees. Independent of the PTS, younger patients, those with a shorter time from injury to surgery, and those with a smaller graft size were found to undergo revision surgery more often.publishedVersio

Evaluating routine blood tests according to clinical symptoms and diagnostic criteria in individuals with myalgic encephalomyelitis/chronic fatigue syndrome

There is a lack of research regarding blood tests within individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and between patients and healthy controls. We aimed to compare results of routine blood tests between patients and healthy controls. Data from 149 patients diagnosed with ME/CFS based on clinical and psychiatric evaluation as well as on the DePaul Symptom Questionnaire, and data from 264 healthy controls recruited from blood donors were compared. One-way ANCOVA was conducted to examine differences between ME/CFS patients and healthy controls, adjusting for age and gender. Patients had higher sedimentation rate (mean difference: 1.38, 95% CI: 0.045 to 2.714), leukocytes (mean difference: 0.59, 95% CI: 0.248 to 0.932), lymphocytes (mean difference: 0.27, 95% CI: 0.145 to 0.395), neutrophils (mean difference: 0.34, 95% CI: 0.0 89 to 0.591), monocytes (mean difference: 0.34, 95% CI: 0.309 to 0.371), ferritin (mean difference: 28.13, 95% CI: −1.41 to 57.672), vitamin B12 (mean difference: 83.43, 95% CI: 62.89 to 124.211), calcium (mean difference: 0.02, 95% CI: −0.02 to 0.06), alanine transaminase (mean difference: 3.30, 95% CI: −1.37 to -7.971), low-density lipoproteins (mean difference: 0.45, 95% CI: 0.104 to 0.796), and total proteins (mean difference: 1.53, 95% CI: −0.945 to 4.005) than control subjects. The patients had lower potassium levels (mean difference: 0.11, 95% CI: 0.056 to 0.164), creatinine (mean difference: 2.60, 95% CI: 0.126 to 5.074) and creatine kinase (CK) (mean difference: 37.57, 95% CI: −0.282 to 75.422) compared to the healthy controls. Lower CK and creatinine levels may suggest muscle damage and metabolic abnormalities in ME/CFS patients.publishedVersio

The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction

Background: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. Purpose: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. Results: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. Conclusion: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.publishedVersio

Anterior cruciate ligament—return to sport after injury scale: validation of the Norwegian language version

Purpose Evidence is emerging on the importance of psychological readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) is developed to assess this. The aim of the current study was to translate ACL-RSI into Norwegian and examine the measurement properties of the Norwegian version (ACL-RSI-No). Methods ACL-RSI was translated according to international guidelines. A cohort of 197 ACL-reconstructed patients completed ACL-RSI-No and related questionnaires nine months post-surgery. One hundred and forty-six patients completed hop tests and 142 patients completed strength tests. Face and structural validity (confirmative factor analysis and explorative analyses), internal consistency [Cronbach’s alpha (α)], test–retest reliability [Intraclass Correlation Coefficients (ICC)], measurement error [Standard error of measurement (SEM) and smallest detectable change at individual (SDCind) and group level (SDCgroup)] and construct validity (hypotheses testing; independent t tests, Pearson’s r) were examined. Results ACL-RSI-No had good face validity. Factor analyses suggested that the use of a sum score is reasonable. Internal consistency and test–retest reliability were good (α 0.95, ICC 0.94 (95% CI 0.84–0.97) and measurement error low (SEM 5.7). SDCind was 15.8 points and SDCgroup was 2.0. Six of seven hypotheses were confirmed. Conclusions ACL-RSI-No displayed good measurement properties. Factor analyses suggested one underlying explanatory factor for “psychological readiness”—supporting the use of a single sum score. ACL-RSI-No can be used in the evaluation of psychological readiness to return to sport after ACL injury. Level of evidence III.publishedVersio

Biological variation of secretoneurin; a novel cardiovascular biomarker implicated in arrhythmogenesis

Background Secretoneurin is a novel prognostic biomarker that may predict mortality in heart failure and the occurrence of ventricular arrhythmias. This study reports the within subject variation (CVI), between subject variation (CVG), reference change values (RCV) and index of individuality (II) of secretoneurin. Methods Thirty healthy volunteers were included. Non-fasting samples were obtained between 8 and 10 am once a week for ten weeks. Secretoneurin was analyzed in duplicate using ELISA. No outliers were present according to Burnett and Reeds‘ criteria. Simple linear regression did not identify significant trends. Variance homogeneity in the analytical variance and CVI were tested using Cochrane’s and Bartlett’s tests and four participants were excluded. Calculation of CVI, CVG and RCV were done on ln transformed data as described by Fokkema, the II was calculated using retransformed data. Results The median age of the participants was 36 years and 53% were female. Non-fasting glucose, eGFR(CKD-EPI), cTnT and NT-proBNP concentrations were within the normal range. Median secretoneurin concentrations were 38 pmol/L (women) and 33 pmol/L (men), p-value < 0.001. CVI and CVG were 9.8% (CI 8.7% to 11.0%) and 20.0 (CI 15.4% to 28.0%), respectively. RCV were 38.7% (CI 35.5% to 42.7%) and −27.9 (CI −29.9 to −26.2) and the II were 0.60 (CI 0.42–0.78). No gender differences were present. Conclusion Secretoneurin has a fairly low CVI, CVG, RCV and II, indicating that it could be suitable as a diagnostic or prognostic biomarker and that delta values in serial samplings may be preferable for identifying clinical changes.publishedVersio

DNA barcode reference libraries for the monitoring of aquatic biota in Europe: Gap-analysis and recommendations for future work

Effective identification of species using short DNA fragments (DNA barcoding and DNA metabarcoding) requires reliable sequence reference libraries of known taxa. Both taxonomically comprehensive coverage and content quality are important for sufficient accuracy. For aquatic ecosystems in Europe, reliable barcode reference libraries are particularly important if molecular identification tools are to be implemented in biomonitoring and reports in the context of the EU Water Framework Directive (WFD) and the Marine Strategy Framework Directive (MSFD). We analysed gaps in the two most important reference databases, Barcode of Life Data Systems (BOLD) and NCBI GenBank, with a focus on the taxa most frequently used in WFD and MSFD. Our analyses show that coverage varies strongly among taxonomic groups, and among geographic regions. In general, groups that were actively targeted in barcode projects (e.g. fish, true bugs, caddisflies and vascular plants) are well represented in the barcode libraries, while others have fewer records (e.g. marine molluscs, ascidians, and freshwater diatoms). We also found that species monitored in several countries often are represented by barcodes in reference libraries, while species monitored in a single country frequently lack sequence records. A large proportion of species (up to 50%) in several taxonomic groups are only represented by private data in BOLD. Our results have implications for the future strategy to fill existing gaps in barcode libraries, especially if DNA metabarcoding is to be used in the monitoring of European aquatic biota under the WFD and MSFD. For example, missing species relevant to monitoring in multiple countries should be prioritized for future collaborative programs. We also discuss why a strategy for quality control and quality assurance of barcode reference libraries is needed and recommend future steps to ensure full utilisation of metabarcoding in aquatic biomonitoring.This paper is a deliverable of the European Cooperation in Science and Technology (COST) Action DNAqua-Net (CA15219) Working Group 1, led by Torbjørn Ekrem and Fedor Čiampor. Thanks to the University of Minho and University of Pécs for hosting workshops and working group meetings. We also thank staff at National Environment Agencies and others that provided national checklists of taxa used in biomonitoring, and otherwise assisted with checklist proof-reading: Jarmila Makovinská and Emília Mišíková Elexová (Slovakia); Steinar Sandøy and Dag Rosland (Norway); Mišel Jelič (Croatia); Marlen Vasquez (Cyprus); Adam Petrusek (Czech Republic); Kristel Panksep (Estonia); Panagiotis Kaspiditis (Greece); Matteo Montagna (Italy); Marija Katarzyte (Lithuania); Ana Rotter (Slovenia); Rosa Trabajo (Spain); Florian Altermatt (Switzerland); Kristian Meissner (Finland), Rigers Bakiu (Albania), Valentina Stamenkovic and Jelena Hinic (Macedonia); Patricia Mergen (Belgium); Gael Denys & the French Biodiversity Agency (France); Mary Kelly-Quinn (Ireland); Piotr Panek and Andrzej Zawal (Poland); Cesare Mario Puzzi (Italy); Carole Fitzpatrick (United Kingdom); Simon Vitecek (Austria); Ana Filipa Filipe (Portugal); Peter Anton Stæhr & Anne Winding (Denmark); Michael Monaghan (Germany); Alain Dohet, Lionel L'Hoste, Nora Welschbillig & Luc Ector (Luxembourg), Lujza Keresztes, (Romania). The authors also want to thank Dirk Steinke for providing the original European ERMS list for marine taxa and Florian Malard for comments on the manuscript. The preparation of the AMBI checklist was carried out in the scope of a Short-term Scientific Mission (ECOST-STSM-CA15219-150217- 082111) granted to SD visiting AZTI, Spain. ZC was supported by grants EFOP-3.6.1.-16-2016-00004 and 20765-3/2018/FEKUTSTRAT. TE was supported by the NorBOL-grant (226134/F50) from the Research Coun cil of Norway. BR, FL and MFG contributed through support from the GBOL project, which is generously funded by the German Federal Min istry of Education and Research (FKZ 01LI1101 and 01LI1501). MG contributed through support of the Polish National Science Centre, grants N N303 5794 39 and 2014/15/B/NZ8/00266. SF was funded by the project PORBIOTA - Portuguese E-Infrastructure for Information and Research on Biodiversity (POCI-01-0145-FEDER-022127), supported by Operational Thematic Program for Competitiveness and Internationalization (POCI), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)

DevOps i Norden

DevOps er en videreutvikling av agile metoder, der utviklere og driftere skal jobbe tettere for å tette gapet som har eksistert mellom disse faggruppene med tradisjonelle programvareutviklingsmetoder. Om man prøver å finne en tydelig definisjon av DevOps i litteratur, så kan man finne uklare og tvetydige definisjoner som kan være forskjellige avhengig av hvilken kilde man bruker. I denne masteravhandlingen vil det bli presentert en studie som har blitt gjennomført med fokus på hvordan de som bruker DevOps vil definere begrepet, og hvilke konsekvenser en implementering av DevOps vil medføre i en organisasjon. Konteksten til denne studien har vært en utviklingsavdeling som tilhører en internasjonal programvarebedrift som begynte å implementere DevOps for rundt fem år siden. Avdelingen er lokalisert i Trondheim, og for å få tillatelse av bedriften til å bruke dem som en case måtte vi skrive under på en NDA. Metoden som er brukt er case-studie med bare en case. Flere semi-strukturerte intervjuer ble utført med totalt åtte informanter, og blant informantene kan man finne rollene prosjektleder, utvikler, konsulent og systemarkitekt. Alle intervjuene ble tatt opp. For å analysere dataene ble de transskribert til tekst, for så å bli delt opp individuelt i koder som igjen ble brutt ned i mindre koder. Programmet NVIVO ble brukt for å gjøre denne prosessen lettere. Resultatet av case-studien vår viser at ansatte i en bedrift som bruker DevOps ofte støter på problemer når de skal prøve å definere begrepet. Om man skal definere DevOps, så kan det være nyttig å snakke om DevOps-kultur og teknisk DevOps. Når bedrifter implementerer DevOps, så endrer kulturen seg til å passe beskrivelsen med økt samarbeid, ansvar og involvering fra alle parter i utviklingssyklusen. Man opplever flere fordeler som blant annet bedre flyt i leveringen av produkter, automatisering som fører til sparing av tid og mulighet til å rette feil på kort tid. Det var også noen utfordringer/ulemper assosiert med DevOps, som blant annet vanskeligheter med å bryte gamle rollemønster, prioritering av tid, mangel på relevant kompetanse og utfordringer med å fornye legacy-systemer. Det virker som at de som bruker DevOps liker det, og misnøye eller motstand oppstår når den nye måten å gjøre det på gjør gammel kompetanse overflødig. For å implementere DevOps på en god måte burde man være klar over at en god DevOps-kultur som tilrettelegger for økt samarbeid vil være viktig for at implementeringen blir en suksess. Det vil også være viktig at implementering er flytende, og at man implementerer det som faktisk vil være til nytte for bedriften. I tillegg må man ha både de ansatte og ledelsen med på implementeringen. I konklusjonen konkluderer vi at definisjonen av DevOps har blitt klarere, og at konsekvensene av DevOps har blitt klarere med noen retningslinjer for implementering

DevOps i Norden

DevOps er en videreutvikling av agile metoder, der utviklere og driftere skal jobbe tettere for å tette gapet som har eksistert mellom disse faggruppene med tradisjonelle utviklingsmetoder. Om man prøver å finne en tydelig definisjon av DevOps i litteraturen, så kan man finne uklare og tvetydige definisjoner som kan være forskjellige avhengig av hvilken kilde man bruker. I dette dokumentet vil det bli presentert en studie som har blitt gjennomført med fokus på hvordan de som bruker DevOps vil definere begrepet, og hvilke konsekvenser en implementering av DevOps vil medføre i en organisasjon. Konteksten til denne studien vil være en avdeling som tilhører en internasjonal programvarebedrift som begynte å implementere DevOps for rundt fem år siden. Avdelingen er lokalisert i Trondheim, og for å få tillatelse av bedriften til å bruke dem som en case måtte vi skrive under på en NDA. Metoden som er brukt er case-studie med bare en case. Flere semi-strukturerte intervjuer ble utført med totalt åtte informanter, og blant informantene kan man finne rollene prosjektleder, utvikler, konsulent og arkitekt. Alle intervjuene ble tatt opp. For å analysere dataene ble de transskribert til tekst, for så å bli delt opp individuelt i koder som igjen ble brutt ned i mindre koder. Programmet NVIVO ble brukt å gjøre denne prosessen lettere. Resultatet av case-studien vår viste at ansatte i en bedrift som bruker DevOps støter ofte på problemer når de skal prøve å definere begrepet, gjerne fordi at de ikke er veldig involvert. Om man skal definere DevOps, så kan det være nyttig å snakke om DevOps-kultur og teknisk DevOps. Når bedrifter implementerer DevOps, så endrer kulturen seg til å passe beskrivelsen med økt samarbeid, ansvar og involvering fra alle parter i utviklingssyklusen. Man opplever flere fordeler som blant annet bedre flyt i leveringen av produkter, automatisering som fører til sparing av tid og mulighet til å rette feil på kort tid. Det var også noen utfordringer/ulemper assosiert med DevOps, som blant annet vanskeligheter med å bryte gamle rollemønster, prioritering av tid, mangel på relevant kompetanse og utfordringer med å fornye legacy-systemer. Det virker som at de som bruker DevOps liker det, og misnøye eller motstand oppstår helst når den nye måten å gjøre det på gjør gammel kompetanse overflødig. For å implementere DevOps på en god måte burde man være klar over at en god DevOps-kultur som tilrettelegger for økt samarbeid vil være viktig for at implementeringen blir en suksess. Det vil også være viktig at implementering er flytende, og at man implementerer det som faktisk vil være til nytte for bedriften. I tillegg må man ha både de ansatte og ledelsen med på implementeringen. I konklusjonen konkluderer vi med at definisjonen av DevOps har blitt litt klarere, og at konsekvensene av DevOps har blitt litt klarere med noen retningslinjer for implementering