Achilles Tendon Ruptures Predictors; functional and economic impact

Acute Achilles tendon rupture is a common injury, which leads to significant morbidity in patients. Many patients never recover their full function even after long rehabilitation, whereas others make a good recovery. The factors behind this are unknown. The optimal treatment strategy, whether or not to treat surgically, is still controversial. This thesis consists of six studies with the overall aim of finding predictors of outcome, examining the long-term follow-up of re-ruptures and comparing the cost efficiency of two different management strategies. Study I is a cohort study of 45 patients who underwent acute ultrasonography within 72 hours of the index injury. They were randomly allocated to either surgical or non-surgical treatment. Three of four (75%) patients with a diastasis of more than 10 mm treated non-surgically sustained a re-rupture and these were the only re-ruptures in the study group. The patients with a diastasis of more than 5 mm displayed poorer heel-rise function and patient-re-ported outcome if treated non-surgically. Study II is a cross-sectional observational cohort study comprising 256 prospectively randomised patients. At two weeks post-operatively, patients underwent a micro-dialysis investiga-tion and six metabolites were collected. Patients were followed up at three, six and 12 months and the duration of surgery was examined. The results showed that glycerol and glutamate were higher with a longer duration of sur-gery. Interestingly, a longer duration of surgery was correlated with an improved clinical and functional outcome. Study III is a long-term follow-up of patients with an Achilles tendon re-rupture, where validated outcome meas-urements were used to assess lower extremity function and symptoms. Twenty patients with a mean (SD) follow-up of 50.9 (38.1) months were included. This cohort was compared with patients (n=87) treated for primary ruptures. The injured side was significantly worse compared with the healthy side in terms of heel-rise tests. The most inter-esting finding in this study was that patients treated for a re-rupture reported a poorer patient-reported outcome compared with those treated for primary ruptures. Study IV is a health-economic evaluation comparing the cost-effectiveness of surgical and non-surgical treatments. The data were collected prospectively from a randomised controlled trial comprising 100 patients. This study showed that the cost per quality-adjusted life year (QALY) gained is € 45,855 and that surgical treatment is 57% likely to be cost efficient at a willingness to pay per QALY of € 50,000. Study V is a mapping study that develops an algorithm, which converts the Achilles tendon total rupture score (ATRS) to the European Quality of Life-5 dimensions Questionnaire (EQ-5D), which enables detailed health-economic studies related to Achilles tendon injuries. It concludes that the algorithm has a high goodness of fit and can be used in future studies. Study VI comprised 391 patients from five different randomised controlled trials pre-dicting functional and patient-reported outcome one year after an acute Achilles tendon rupture. This study re-vealed that older age is a predictor of poorer outcome and that surgically treated patients have a tendency towards superior recovery in terms of heel-rise height. Taken together, this thesis shows that ultrasonography could be potentially useful in predicting the risk of re-rup-ture and outcome in acute Achilles tendon rupture. It also demonstrates that a longer duration of surgery leads to the upregulation of healing metabolites. Patients who have sustained a re-rupture have long-term deficits in terms of function and a poorer patient-reported outcome than those with primary ruptures. Moreover, it provides the first cost-effectiveness analysis in this field of research and develops an algorithm for future health-economic studies. Finally, it concludes that older age is a strong predictor of poorer heel-rise height at one year

Godsflödesanalyser för Trafikverket region Nord och Mitt

Denna rapport är framtagen och finansierad på uppdrag av Trafikverket Region Nord och Region Mitt. Syftet med rapporten har varit är att sammanställa och redovisa godsflöden längs vägar, järnvägar och sjörutter i Trafikverkets region Nord och Mitt så som de beskrivs i Trafikverkets Samgodsmodell. Trafikverkets Samgodsmodell är central för Trafikverkets inriktnings- och åtgärdsplanering, vid skapandet av en lägesbild över godsflöden och godstransportefterfrågan i regionen är det därför viktigt att bygga arbetet utifrån denna modell

Den hållbara regionen : Om förutsättningar och framtidsmöjligheter för en hållbar samhällsutveckling i Västerbottens län - ett projektförslag

På uppdrag av Miljöhögskolan vid Umeå universitet har Centrum för regionalvetenskap (CERUM) utfört en inledande sondering och en preliminär förstudie där syftet har varit att lägga grunden för ett tvärvetenskapligt forskningsprojekt baserat på en vid definition av begreppet ”hållbar utveckling”. Projektets vetenskapliga bas är lagd med huvudvikt på samhällsvetenskapliga och humanistiska analysdimensioner, vilket inte utesluter de, i dessa sammanhang mer vanligen förekommande, naturvetenskapliga och teknologiska analys-dimensioner.Som en väsentlig del av denna förstudie ingår att samla/skapa en forskargrupp bestående av forskare från olika discipliner företrädesvis från Umeå universitet, samt att formulera en plan över en fördjupningsstudie. Koordinator för projektet är för närvarande Olof Stjernström, CERUM och Kulturgeografiska institutionen, Umeå universitet

Detection of Alzheimer peptides and chemokines in the aqueous humor

PURPOSE. Alzheimer disease (AD) and age-related ocular diseases are characterized by inflammation and accumulation of insoluble proteins. We aimed to investigate the detectability and clinical relevance of a panel of AD-related markers, such as Alzheimer peptides and chemokines, in the aqueous humor (AH) samples taken from patients with cataract only, or cataract and 1 other ocular disease. METHODS. The AH samples were obtained during cataract surgery from patients with cataract only (n=162), cataract and glaucoma (n=21), cataract and exfoliation (PEX) (n=31), cataract and macular degeneration (n=36), and cataract and diabetic retinopathy (n=16). The AD peptides (A beta(1-42), A beta(1-40), A beta(1-38)) and chemokines (eotaxin, eotaxin 3, interleukin [IL]-8, inducible protein-10, monocyte chemotactic protein [MCP]-1, MCP-4, macrophage-derived chemokine, macrophage inflammatory protein-1 beta, thymus and activation-egulated chemokine) were quantified by using multiplex immunoassays. RESULTS. The levels of the AH peptides (A beta(1-38), A beta(1-40), A beta(1-42)) did not differ between disease groups. Independently of disease group, the A beta(1-38) levels correlated with A beta(1-40) and A beta(1-42) (p<0.001, n=277). Notably, the ratio A beta(1-42) to A beta(1-38) differed between PEX and macular degeneration (mean 95% confidence interval [CI] =8.12 [11.3-3.99] vs 2.23 [2.67-0.52], p=0.003). Among chemokines examined, only MCP-1 and IL-8 were detected in about 90% to 46% of all analyzed (n=266) samples. Higher levels of AH IL-8 were found in the glaucoma group than in cataract only (p=0.011). Independently of disease group, a correlation was observed between AH MCP-1 and IL-8 (rho=0.275, p<0.001, n=266) and between MCP-1 and A beta(1-40) (rho=0.239, p<0.001, n=266). CONCLUSIONS. Our findings highlight pathologic similarities between AD and eye diseases, and show the potential of modern technologies to detect AD biomarkers in age-related eye diseases

The SunBurst trial : a register-based, randomized controlled trial on thoracolumbar burst fractures

BACKGROUND AND PURPOSE:  The treatment for patients with thoracolumbar burst fractures without neurological deficit or complete rupture of the posterior ligament complex (PLC) is controversial and includes both surgical and non-surgical options. Current evidence on which treatment is optimal remains inconclusive. In this study we compare surgical with non-surgical treatment. METHODS:  The study is a nationwide, multicenter, register-based randomized controlled trial (R-RCT). Patients with a thoracolumbar burst fracture will be identified by the Swedish Fracture Register. The admitting physician will be notified during the registration process and the patient will be screened for eligibility. Patients, 18 to 66 years old without neurologic deficit to more than a single nerve root and without complete rupture of the PLC, are eligible for the study. 202 patients will be randomized in a 1:1 relation to either surgical or non-surgical treatment. Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and radiological data, will be collected at the time of injury, after 3-4 months, and after 1 year. Additional data from national health registries will be collected after 1 year. OUTCOME:  The primary outcome is the ODI 1 year after injury. Secondary outcomes include additional PROMs, adverse events, drug consumption, sick leave, healthcare consumption, and imaging data. INTERPRETATION:  The primary outcome is the ODI 1 year after injury. Secondary outcomes include additional PROMs, adverse events, drug consumption, sick leave, healthcare consumption, and imaging data. Estimated duration - The study started on September 1, 2021 and will continue for approximately 4 years. Trial registration - The trial is registered at www.clinicaltrials.com, NCT05003180

Validity of the short musculoskeletal function assessment questionnaire in patients with a spine fracture

PURPOSE: The aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture. METHODS: Cross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman's rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland-Altman plots were used to assess PROM agreement. RESULTS: 82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71-0.87 for ODI, 0.72-0.84 for EQ-5D-3L index, and 0.67-0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland-Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS. CONCLUSION: The SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI

Upphandling av drift och vägunderhåll i norra Sveriges inland : om marknadsförutsättningar och regionala effekter

digitalisering@um