Bisphosphonates and Atypical Fractures of Femur

Bisphosphonates are the most widely prescribed medicines for the treatment of osteoporosis and have generally been regarded as well-tolerated and safe drugs. Since 2005, there have been numerous case reports about atypical fractures of the femur linked to long-term treatment of osteoporosis with bisphosphonates. Some attempts to characterize pathophysiology and epidemiology of these fractures have been published as well. However, as the American Society for Bone and Mineral Research (ASBMR) concluded in their task force report, the subject warrants further studies

Memory and mood effects of auditory deep sleep stimulation

Objectives: In recent years, scientific inquiry has been able to dig into the effects of sleep on memory. More specifically, slow oscillations (SO) detected with EEG during deep sleep, have been found to reactivate memory representations which further enhances their processing and consolidation into long-term memory. In previous studies, auditory stimulation during deep sleep has been found to strengthen the brain's natural SO cycles and enhance consolidation of declarative memory but it has also been found to have unwanted side-effects on mood. This study is part of a research project, Sound Deep Sleep, where the objective is to develop a non-pharmacological method for home use to enhance the positive effects of deep sleep using auditory stimulation. In this study the effects of different auditory stimuli and their duration on memory consolidation and mood was investigated. Methods: 21 healthy adult volunteers took part in the study. The subjects slept in a sleep research lab in the Institute of Occupational Health for four nights with electrodes attached to the scalp and their memory performance and mood was tested once every evening and once every morning. Memory performance was tested with paired associative words, face-name test and with sequential finger tapping. Subject's mood was tested with POMS questionnaire and task load with NASA-TLX. During the four nights, subjects were presented with brief auditory noise or percussion sounds for the whole night of for the first four hours or with no auditory stimulation in a randomized order. The auditory stimulation was time locked to SO cycles according to online detection by a previously developed algorithm. The volume of the sound was adjusted according to online detection of sleep depth by the same algorithm. Results and conclusions: Auditory stimulation did not affect memory consolidation, mood, task load or subject's sleep architecture. The results on memory consolidation are contradictory to previously published data and possible explanations for the contradiction are discussed. The fact that this study had larger sample size and almost identical design than previous studies casts doubt that the effects size of auditory stimulation on memory consolidation might be smaller than previously expected or that it concerns only a sub-population of people. Based on the results of this study, suggestions for future research designs are introduced.Tavoitteet: Unen merkitys normaalin muistin toiminnan ja muistiin tallennuksen kannalta on alkanut valjeta tieteellisen tutkimuksen kautta viime vuosina. EEG:ssä syvän unen aikana havaittavien hidasaaltojen on todettu uudelleenaktivoivan tuoreita muistijälkiä prosessoiden niiden sisältöjä edelleen ja vahvistaen niiden tallennusta kestomuistiin. Aiemmissa tutkimuksissa lyhyiden ääniärsykkeiden on todettu voimistavan aivojen luontaista hidasaaltorytmiä ja parantavan deklaratiivisen aineksen tallennusta kestomuistiin, mutta myös haittaavan unen jälkeistä mielialaa. Tämä tutkimus liittyy Sound Deep Sleep tutkimusprojektiin, jossa kehitetään kotikäyttöistä lääkkeetöntä keinoa hidasaaltorytmin voimistamiseen lyhyiden, hidasaaltoon vaihelukittujen ääniärsykkeiden avulla. Tutkielmassa selvitettiin äänten esittämisajan ja ääniärsykkeen miellyttävyyden vaikutusta muistisuoriutumiseen ja mielialaan. Menetelmät: 21 tervettä vapaaehtoista aikuista koehenkilöä osallistui tutkimukseen. He nukkuivat Työterveyslaitoksen unilaboratoriossa neljä yötä, joiden aikana heidän aivosähkökäyrää, muistisuoriutumista ja mielialaa mitattiin. Muistisuoriutumista mitattiin assosioituvien sanaparien tehtävällä, nimimuistitehtävällä ja sorminaputtelutehtävällä kerran illalla ja toisen kerran aamulla. Mielialaa mitattiin POMS kyselyllä ja kuormitusta NASA-TLX kyselyllä. Neljän yön aikana koehenkilöille esitettiin satunnaisessa järjestyksessä joko koko yön tai yön ensimmäisen neljän tunnin ajan lyhyitä kohinapurskeääniä, koko yön perkussiosoitinääniä tai ei mitään ääniä. Äänet esitettiin etukäteen valmistetun ohjelman tunnistaman hidasaallon aikana ja siten, että äänenvoimakkuuden säätely tapahtui automaattisesti koehenkilön unen syvyyden mukaan. Tulokset ja johtopäätökset: Koetilanteella ei havaittu olevan vaikutusta koehenkilöiden muistisuoriutumiseen, mielialaan, kuormittuneisuuteen tai unen rakenteeseen. Muistisuoritusten osalta tulokset ovat ristiriidassa aiemman tutkimusaineiston kanssa ja mahdollisia selityksiä tähän käsitellään tarkemmin. Aiempiin tutkimuksiin nähden suurempi otoskoko, mutta identtinen koeasetelma viittaavat äänten esittämisen vaikutuksen olevan luultua pienempi tai koskevan vain tiettyä ryhmää ihmisistä. Ehdotuksia menetelmän jatkokehitykseen käydään läpi tämän tutkimuksen tulosten pohjalta

Risk factors for early readmission due to surgical complications after treatment of proximal femoral fractures - A Finnish National Database study of 68,800 patients

Introduction: Hip fracture surgery is associated with a considerable amount medical and surgical complications, which adversely impacts the patient's outcome and/or increases costs. We evaluated what risk factors were associated with the occurrence of early readmission due to surgical complications after hip fracture surgery. Material and methods: A nationwide database with 68,800 hip fracture patients treated between 1999 and 2011 was studied to uncover the association of readmissions with co-morbidities, fracture types, different hospital types and treatment methods using the Cox proportional hazards model. Results: Early readmission within three months due to hip fracture surgery complications occurred at a rate of 4.6%. Increased occurrence of readmission was found among patients with: heavy alcoholism (HR 1.38; 95% CI: 1.23-1.53); Parkinson's disease (PD; HR 1.22; 95% CI: 1.05-1.42); pre-existing osteoarthritis (HR 2.02; 95% CI: 1.83-2.23); rheumatic disease (HR 1.44; 95% CI: 1.27-1.65); as well as those with a fracture of the femur neck, depression, presence of a psychotic disorder, an operative delay of at least three days, or previous treatment with total hip arthroplasty. Conclusion: Our results indicate that there are several factors associated with an increased risk of early readmission. We suggest that in the presence of these factors, the surgical treatment method and postoperative protocol should be carefully planned and performed. (C) 2018 The Authors. Published by Elsevier Ltd.Peer reviewe

Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures?

Peer reviewe

The effect of type of femoral component fixation on mortality and morbidity after hip hemiarthroplasty:A systematic review and meta-analysis

Background: Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. Questions/Purposes: The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. Results: The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. Conclusions: While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed

Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. ----- PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. ----- RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. ----- CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis

Hiekanerotuksen ja hiekkapesuprosessin kehittäminen Turun seudun puhdistamo Oy:ssä

Hiekanerotus ja hiekkapesuprosessi ovat osa jäteveden esikäsittelyä ja niiden tarkoituksena on poistaa prosessista jäteveden mukana puhdistamolle kulkeutuva hiekka. Optimaalisesti toimiva hiekanerotus takaa, ettei hiekka pääse kulkeutumaan prosessissa eteenpäin ja aiheuta vahinkoa prosessille. Hiekanpesulla erotettu kiintoaines pestään, jotta se voidaan kuljettaa kaatopaikalle. Tämän opinnäytetyön tarkoituksena on kehittää Turun seudun puhdistamo Oy:n hiekanerotus ja hiekkapesuprosesseja. Kehitysideoita haettiin haastatteluiden, laitosvierailuiden ja käytännönkokeiden avulla. Käytännön kokeista kävi ilmi, että hiekkapesureiden läpi pääsee karkaamaan huomattavia määriä orgaanista ainesta ja vettä. Tämä johtuu siitä, että hiekkapesureille kulkeutuu hiekanerotusaltailta välpettä, joka sotkeutuu hiekkapesurien sekoittimiin ja estää pesurin toimintaa. Laitosvierailuilla huomattiin, että esikäsittely voidaan toteuttaa monella tavalla ja havainnoitiin, että hiekkapesurin mallilla voi olla selkeä vaikutus puhdistus tuloksiin. Tässä opinnäytetyössä esitellään erilaisia ratkaisuja, joilla prosessia voidaan kehittää. Tärkeää on pystyä vähentämään hiekkapesureille tulevaa välppeen määrää. Tämä voidaan toteuttaa esimerkiksi uusilla karkeavälpillä, jotka rajoittavat hiekanerotusaltaille kulkeutuvan välppeen määrää. Erityisen tärkeässä asemassa ovat itse hiekkapesurit. Saatujen havaintojen ja nykytilanteen perusteella uusien hiekkapesurien hankinta on perusteltua, jotta tulevaisuudessa voimaan astuvan kaatopaikkalain asettamat rajat tulevat täyttymään. Pesurit säästäisivät kuljetuskustannuksissa ja ideaalitilanteessa pestyä hiekka voitaisiin käyttää hyödyksi esimerkiksi ympäristörakentamisessa. Opinnäytetyön jälkeen Turun seudun puhdistamo Oy aloitti muutostyöt joissa karkeavälppien säleväliä pienennettiin, tilattiin uudet hiekkapesurit ja niiden yhteyteen hankitaan rejektivesivälppä.Grit removal and grit washing are part of the preprocessing of wastewater and their purpose is to remove the sand which is carried to the wastewater treatment plant with the incoming wastewater. An optimally functioning grit removal process guarantees that grit is prevented from being carried forward in the process and causing damage to the process. Grit separated with the grit washer is washed so that it can be transported to a land fill site. The purpose of this thesis was to develop the grit removal and grit wash processes of Turun seudun puhdistamo Oy. Research data was gathered through interviews, institution visits and empirical tests. The empirical tests showed that considerable amounts of organic material and water are able to escape through the grit washer. This is due to the fact that fibrous material in the grit which is carried from the grit removal process gets tangled in the mixers of the grit washers and prevents the operation of the washers. During the institution visits it was noticed that the preprocessing can be carried out in many ways and it was observed that the model of the grit washer can have a clear effect on the washing results. In this thesis different solutions which can be used to develop the process are presented. It is important to be able to reduce the amount of fibrous grit that is carried to the grit washers. This can be achieved for example with new wastewater screens which restrict the amount of screening that would be normally carried to the grit washers. The grit washers are especially important. On the basis of observations and the present situation the acquisition of new grit washers is justified so that the set limits of future environmental laws are met. New grit washers would save in transportation costs since the amount of organic material in grit would decline and in the ideal situation the washed sand from the grit washers could be used in environment building. After this thesis project entered its written phase Turun seudun puhdistamo Oy began alteration work in which the screen space of the screens was reduced, new grit washers were ordered and complemented with a drum screen that processes the separated organic solids

Uusi viinilista Ravintola Kaislaan kesäksi 2012

Opinnäytetyön aiheena on suunnitella uusi viinilista Tamperelaiseen à la carte -ravintolaan. Ravintola Kaisla on keskikokoinen kesäravintola, jonka ruokalista koostuu eri ruoista ja raaka-aineista eri puolelta maailmaa. Viinilistan rakenteen suunnittelussa käytettiin pääasiallisesti ruoan ja viinin yhdistämisen teoriaan perustuvaa ruokalistan analyysia. Tärkein tekijä viinien valinnassa oli, että listalta löytyisi ainakin yksi sopiva viini kullekin ruokalistan annokselle. Tärkeää oli kuitenkin pitää lista tarpeeksi suppeana. Viinejä valitessa, tuotteiden hintaluokka piti ottaa myös huomioon. Huomioiden paikan liikeidean, pääpaino tuotteiden hinnoissa sijoittui keskihintaisiin viineihin. Edellisvuosien myyntitilastoja käytettiin analysoimaan Kaislan asiakkaiden mieltymykset. Myös liikesuhteet eri viinitoimittajien kanssa asetti viinilistasuunnitteluun omat reunaehtonsa. Lopulta laatu sekä valittujen viinien ominaisuudet testattiin subjektiivisella maistamisella. Lopulta listalle valittiin 28 viiniä: seitsemän punaviiniä, seitsemän valkoviiniä, viisi jälkiruokaviiniä, kaksi roseviiniä sekä seitsemän kuohuviiniä, mukaan lukien kaksi samppanjaa. Ravintolan ruokalistaan lisättiin viinisuositukset jokaiselle ruoka-annokselle. Korkeatasoisen palvelun takaamiseksi, järjestettiin alkukesällä koulutus uusista viineistä ravintolan henkilökunnalle.The aim of this thesis was to create a wine list for a Finnish à la carte restaurant. Restaurant Kaisla is a mid-sized summer restaurant with a diverse menu mixing dishes from a variety of cuisines. The principal method for designing the overall structure of the wine list was the analysis of the restaurant menu, based on the theory of combining wine and food. The most important factor considered in the wine selection process was that there would be at least one complementary wine for each dish on the menu, while still keeping the list size manageable. The price level was also taken into account: due to the restaurant's business concept, the focus was on affordable and mid-priced wines. Wine sales data from the previous summer was analysed to determine the preferences of Kaisla's customer base. In addition, existing business relationships between the restaurant and different beverage suppliers set some boundary conditions on the available selection. Finally, the quality and characteristics of the specific wines chosen were verified by subjective tasting. In the end, 28 wines were chosen: 7 red wines, 7 white wines, 5 dessert wines, 2 rosé wines, and 7 sparkling wines, including two Champagnes. The restaurant menu was augmented with two recommendations from the wine list for each dish. Furthermore, to ensure high quality service, wine training was organised for the restaurant staff during the summer