Bone mineral density after implantation of a femoral neck hip prosthesis – a prospective 5 year follow-up

BACKGROUND: Bone resorption in the proximal femur due to stress shielding has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to prospectively investigate the in vivo changes of bone-mineral density as a parameter of bone remodeling around a short, femoral neck prosthesis over the first 5 years following implantation. The secondary goal was to report on its clinical outcome. METHODS: We are reporting on the changes of bone mineral density of the proximal femur and the clinical outcome up to five years after implantation of a short femoral neck prosthesis. Bone mineral density was determined using dual energy x-ray absorptiometry, performed 10 days, three, 12 and 60 months after surgery. 20 patients with a mean age of 47 years (range 17 to 65) were clinically assessed using the Harris Hip Score. The WOMAC was used as a patient-relevant outcome-measure. RESULTS: In contrast to conventional implants DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation. The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 91 points and 95 points at 60 months, the global WOMAC index from 5.3 preoperatively to 0.8 at 12 months and 0.6 at 60 months postoperatively. CONCLUSION: At 60 months after implantation of a short femoral neck prosthesis, all regions except one (region of interest #5) showed no significant changes in BMD compared to baseline measurements at 10 days which is less to the changes in bone mineral density seen in conventional implants

Investigations on the development of a computer-based training program to teach helminthology in dogs and cats

Titelblatt, Inhaltsverzeichnis, Danksagung, Lebenslauf 1\. Einleitung/Literatur 3\. Material und Methode 4\. Ergebnisse 5\. Diskussion 6\. Zusammenfassung 7\. Summary 8\. Anhang 9\. LiteraturverzeichnisDie CD-ROM "Rund- und Bandwürmer bei Hund und Katze" ist ein computergestütztes Lern- und Informationsprogramm für Studierende der Veterinärmedizin, praktische Tierärzte und Tierarzthelferinnnen. Das Programm stellt auf 248 Bildschirmseiten und über 150 einzublendenden Schautafeln wichtige Helminthosen von Hund und Katze vor. Das Lernprogramm wurde als Informationssystem konzipiert. In Hinblick auf eine stärkere Betonung des eigenverantwortlichen Lernens im Gegensatz zum bevormundenden Lehren wurde die Anleitung durch den Computer stark eingeschränkt. Zugunsten einer aktiveren Beteiligung des Lernenden wurde darauf verzichtet, Lernziele zu definieren und das Auswendiglernen und Abfragen von Fakten zu unterstützen. Der parasitologisch Interessierte soll vielmehr selbst bestimmen, welche Informationen er abrufen und welche Aspekte des Themengebietes er bearbeiten will. Er kann hierzu aus einer breiten Datenbasis auswählen und soll so seine Fähigkeit des Umgangs mit Informationen schulen. Des weiteren wurde besonderer Wert darauf gelegt, ein Teilgebiet der Veterinärmedizin in einer Form aufzubereiten, die die Möglichkeiten der multimedialen Darstellung ausschöpft. Komplexe Sachverhalte wie Lebenszyklen, parasitologische Untersuchungsverfahren und Entwurmungspläne werden durch interaktive Zugriffsmöglichkeiten und multimediale Darstellung in Text, Bild und Ton für den Neuling auf dem Gebiet der Parasitologie eingängig dargestellt. Zur Illustration des Inhaltes werden 20 Audiosequenzen, 15 Videoclips, mehr als 40 Animationen und über 300 Abbildungen verwendet. Die umfangreiche Beschreibung der einzelnen Parasitenarten ermöglicht aber auch dem weitergehend interessierten Nutzer eine Vertiefung seines Wissens und gezieltes Nachschlagen relevanter Informationen. In der vorliegenden Arbeit werden die bei der Entwicklung des Programmes gemachten Erkenntnisse dokumentiert. Eigene Erfahrungen und im Schrifttum belegte Empfehlungen zur Konzeption und Umsetzung eines computergestützten Lernprogrammes werden zusammengefaßt. Anhand der Literatur wird ein Überblick über die vorhandenen Lehrmedien in der Parasitologie gegeben.The CD-ROM "Rund- und Bandwürmer bei Hund und Katze" is a computer-based training program to teach helminthology in dogs and cats for veterinary students, practitioners and veterinary nurses. On 248 screens and more than 150 viewers important round- and tapeworm infections of dogs and cats are explained. The learning program was developed to operate as an information system. The tutorial and teaching function of the computer was minimised in favour of a more flexible learning environment, permitting the student to be more in charge of his own learning process. To support a more active involvement of the learner, no stringent learning objectives were defined. Rote learning and assessment of factual knowledge are not provided by the program. Instead the student is meant to decide himself, which information to obtain and which topics of the subject to work with. For these purposes he has access to a broad database. The use of this database is intended to train his information management skills. In addition the authors wanted to prepare one aspect of veterinary medicine (i.e. helminthology) in a form that employs the capacity of multimedial presentation. Complicated topics of parasitology like lifecycles, diagnostic methods and deworming schedules are simplified for the beginner by interactive and multimedial presentation. To illustrate the contents, 20 audiosequences, 15 videoclips, more than 40 animations and 300 pictures are used. The extensive description of the different parasite species enables the advanced user to increase his knowledge or look up relevant information. In this thesis the experiences made during the development of this learning program are documented. Own results as well as recommendations from literature on the conception and production of a computer-based learning program are compiled

Sin, Impurity, and Community in Leviticus 16

The Book of Leviticus contains a considerable amount of material pertaining to sin, covering a great variety of types of behaviour that incur sin, methods for atonement, punishments, and ritual context for sin offerings. This thesis considers the nature of sin and its function in society, as depicted in Leviticus 16, by means of comparing several different theological and anthropological models regarding sin and impurity, in combination with a close reading of the Hebrew. The image of sin and impurity that emerges includes a dual system of ritual and moral impurity, which in part could well be used to establish a social structure and hierarchy, and is in Leviticus 16 put in service of promoting the role of the High Priest as the mediator between God and the Israelites, and the only one capable of maintaining and fixing that relationship in the face of sin and impurity

Effectiveness of a MF-59™-adjuvanted pandemic influenza vaccine to prevent 2009 A/H1N1 influenza-related hospitalisation; a matched case-control study

Background: During the 2009 influenza A/H1N1 pandemic, adjuvanted influenza vaccines were used for the first time on a large scale. Results on the effectiveness of the vaccines in preventing 2009 influenza A/H1N1-related hospitalisation are scanty and varying.Methods: We conducted a matched case-control study in individuals with an indication for vaccination due to underlying medical conditions and/or age ≥ 60 years in the Netherlands. Cases were patients hospitalised with laboratory-confirmed 2009 A/H1N1 influenza infection between November 16, 2009 and January 15, 2010. Controls were matched to cases on age, sex and type of underlying medical condition(s) and drawn from an extensive general practitioner network. Conditional logistic regression was used to estimate the vaccine effectiveness (VE = 1 - OR). Different sensitivity analyses were used to assess confounding by severity of underlying medical condition(s) and the effect of different assumptions for missing dates of vaccination.Results: 149 cases and 28,238 matched controls were included. It was estimated that 22% of the cases and 28% of the controls received vaccination more than 7 days before the date of onset of symptoms in cases. A significant number of breakthrough infections were observed. The VE was estimated at 19% (95%CI -28-49). After restricting the analysis to cases with controls suffering from severe underlying medical conditions, the VE was 49% (95%CI 16-69).Conclusions: The number of breakthrough infections, resulting in modest VE estimates, suggests that the MF-59™ adjuvanted vaccine may have had only a limited impact on preventing 2009 influenza A/H1N1-related hospitalisation in this setting. As the main aim of influenza vaccination programmes is to reduce severe influenza-related morbidity and mortality from influenza in persons at high risk of complications, a more effective vaccine, or additional preventive measures, are needed

New insights into the impact of neuro-inflammation in rheumatoid arthritis.

Rheumatoid arthritis (RA) is considered to be, in many respects, an archetypal autoimmune disease that causes activation of pro-inflammatory pathways resulting in joint and systemic inflammation. RA remains a major clinical problem with the development of several new therapies targeted at cytokine inhibition in recent years. In RA, biologic therapies targeted at inhibition of tumor necrosis factor alpha (TNFα) have been shown to reduce joint inflammation, limit erosive change, reduce disability and improve quality of life. The cytokine TNFα has a central role in systemic RA inflammation and has also been shown to have pro-inflammatory effects in the brain. Emerging data suggests there is an important bidirectional communication between the brain and immune system in inflammatory conditions like RA. Recent work has shown how TNF inhibitor therapy in people with RA is protective for Alzheimer's disease. Functional MRI studies to measure brain activation in people with RA to stimulus by finger joint compression, have also shown that those who responded to TNF inhibition showed a significantly greater activation volume in thalamic, limbic, and associative areas of the brain than non-responders. Infections are the main risk of therapies with biologic drugs and infections have been shown to be related to disease flares in RA. Recent basic science data has also emerged suggesting that bacterial components including lipopolysaccharide induce pain by directly activating sensory neurons that modulate inflammation, a previously unsuspected role for the nervous system in host-pathogen interactions. In this review, we discuss the current evidence for neuro-inflammation as an important factor that impacts on disease persistence and pain in RA

Rise of multidrug-resistant non-vaccine serotype 15A Streptococcus pneumoniae in the United Kingdom, 2001 to 2014

Conjugate vaccines have reduced the burden of pneumococcal disease in vaccinated children and unvaccinated adults, but emerging non-vaccine serotypes are concerning, particularly if antibiotic resistant. Against this background, we reviewed serotypes and resistance among pneumococci collected via: (i) the British Society for Antimicrobial Chemotherapy (BSAC) bacteraemia and respiratory surveillances from 2001 to 2014; (ii) Public Health England’s (PHE) ‘invasive isolate’ surveillance from 2005 to 2014 and (iii) received as PHE reference submissions from 2005 to 2014. Representatives were sequenced, with sequence types (STs) deduced. Serotype 15A became increasingly prominent in all series, with many representatives showing ‘triple resistance’ to macrolides, tetracyclines and penicillin. In the PHE and BSAC invasive isolates surveillances, serotype 15A was consistently among the 10 most prevalent types from 2011, but never previously; 26-33% of invasive 15A isolates had triple resistance’. BSAC respiratory isolates were only serotyped in the 2013/4 and 2014/5 (October to September years), with 15A proving the most prevalent serotype in both periods, at 9.1 and 10.7% of isolates, respectively, with 38.2 and 47.8% showing triple resistance. Among pneumococci sent to PHE for resistance investigation, the proportion of 15A isolates was 0-4% annually in the years 2005 to 2008 but rose to 29 and 32% in 2013 and 2014, respectively. Almost all multiresistant 15A isolates were sequence type (ST)63 variants, whereas susceptible 15A isolates were clonally diverse. The rise of resistant serotype 15A pneumococci suggests that pneumococcal conjugate vaccines will need ongoing adaptation

The effect of physical fatigue on oscillatory dynamics of the sensorimotor cortex

Aim: While physical fatigue is known to arise in part from supraspinal mechanisms within the brain exactly how brain activity is modulated during fatigue is not well understood. Therefore, this study examined how typical neural oscillatory responses to voluntary muscle contractions were affected by fatigue. Methods: Eleven healthy adults (age 27±4 years) completed two experimental sessions in a randomised crossover design. Both sessions first assessed baseline maximal voluntary isometric wrist-flexion force (MVFb). Participants then performed an identical series of fourteen test contractions (2 × 100%MVFb, 10 × 40%MVFb, 2 × 100%MVFb) both before and after one of two interventions: forty 12-s contractions at 55%MVFb (fatigue intervention) or 5%MVFb (control intervention). Magnetoencephalography (MEG) was used to characterise both the movement-related mu and beta decrease (MRMD and MRBD) and the post-movement beta rebound (PMBR) within the contralateral sensorimotor cortex during the 40%MVFb test contractions, while the 100%MVFb test contractions were used to monitor physical fatigue. Results: The fatigue intervention induced a substantial physical fatigue that endured throughout the post-intervention measurements (28.9-29.5% decrease in MVF, P<0.001). Fatigue had a significant effect on both PMBR (ANOVA, session × time-point interaction: P=0.018) and MRBD (P=0.021): the magnitude of PMBR increased following the fatigue but not the control interventions, whereas MRBD was decreased post-control but not post-fatigue. Mu oscillations were unchanged throughout both sessions. Conclusion: Physical fatigue resulted in an increased PMBR, and offset attenuations in MRBD associated with task habituation