Accelerometer-measured sedentary time and physical activity—A 15 year follow-up of mortality in a Swedish population-based cohort

Objectives

To investigate the associations of objectively assessed sedentary time, light intensity physical activity (PA), moderate to vigorous intensity PA (MVPA), and total PA with all-cause mortality and mortality from cardiovascular disease (CVD) or cancer in a Swedish population-based cohort with 15 years follow-up time.

Ein eigenartiger Fund (Fall von Sadismus?)

Ohne ZusammenfassungDer Danziger Kriminalpolizei, der ich für die übersendung der PrÄparate au\erordentlich dankbar sein mu\, sind weitere Ähnliche Funde bisher nicht zur Kenntnis gelangt. Auch haben sich Anhaltspunkte für das Treiben eines bis zum Mord am Menschen unter Ähnlichen BegleitumstÄnden gehenden TÄters dort nicht feststellen lassen. Die ausgesprochene Eigenartigkeit dieser Funde, die zweifellos vorhandene Möglichkeit, da\ dahinter das exzentrische Tun eines sadistisch eingestellten geistesgesunden oder geisteskranken TÄters vermutet werden mu\, haben mich, wie ich eingangs ausführte, zu der doppelten Mitteilung nicht nur in einer Polizeizeitschrift, sondern auch in unserer führenden gerichtsÄrztlichen Zeitschrift veranla\t. Ich wÄre für entsprechende Mitteilungen ganz besonders dankbar.     

Compensatory biliary and urinary excretion of gadobenate ion after administration of gadobenate dimeglumine (MultiHance?) in cases of impaired hepatic or renal function: a mechanism that may aid in the prevention of nephrogenic systemic fibrosis?

Objective:

To determine whether increased elimination of gadobenate ion via the hepatobiliary pathway might compensate for reduced/absent elimination via the urinary pathway in the event of compromised renal function, as a possible protective mechanism against nephrogenic systemic fibrosis (NSF).

Methods:

15 male Crl:CD^® R(SD)Br rats (Charles River Italia, Como, Italy) randomized to three treatment groups: (1) animals with occluded bile ducts, (2) animals with occluded renal vessels and (3) control animals, each received 0.25 mmol kg⁻¹ of bodyweight of gadobenate dimeglumine (MultiHance^®; Bracco Imaging SpA, Milan, Italy). Urine and bile were collected from 0−30, 30−60, 60−120, 120−240 and 240−480 min after gadobenate dimeglumine administration prior to exsanguination. Determinations of gadobenate ion in blood, bile and urine were performed by high-performance liquid chromatography. Gadolinium (Gd³⁺) levels in excised liver and kidneys were determined by X-ray fluorescence.

Results:

The recovery of gadobenate ion in the urine of rats with bile duct occlusion was significantly higher than that in the urine of normal rats (89.1 ± 4.2% vs 60.6 ± 2.8%; p < 0.0001). Conversely, mean recovery in the bile of rats with renal vessel occlusion was significantly higher than that in the bile of normal rats (96.16 ± 0.55% vs 33.5 ± 4.7%; p < 0.0001). Gadobenate ion was not quantifiable in any group 8 h post-injection.

Conclusion:

Compensatory elimination may be an effective means to overcome compromised renal or hepatobiliary elimination.

Advances in knowledge:

The absence of NSF in at-risk patients administered with gadobenate dimeglumine may in part reflect greater Gd³⁺ elimination via the hepatobiliary route.Nephrogenic systemic fibrosis (NSF) is a rare, systemic fibrosing disorder characterized by thickening and induration of the skin, flexion contractures and impaired mobility of the nearby joints, as well as fibrosing changes in connective tissues of internal organs.^1,2 Although the first cases of NSF were identified in 1997 and the first published report of 14 cases appeared in 2000,³ it was not until 2006 that a possible association with exposure to gadolinium (Gd³⁺)-based contrast agents (GBCAs) became apparent.⁴ By December 2012, 815 distinct cases of NSF had been reported in 200 articles in the peer-reviewed literature, the vast majority of which [595/815 (73.0%)] were observed in the USA.⁵Most theories on the mechanism behind the development of NSF have focused on GBCA molecular structure and stability as factors determining an increased risk with some agents relative to others.^6,7 Thus, the non-ionic, open-chain (linear) GBCAs, gadodiamide and gadoversetamide, have the lowest kinetic stability and highest propensity to release Gd³⁺ and, as a group, have been associated with the greatest number of unconfounded cases of NSF (approximately 78% with gadodiamide and 1.3% with gadoversetamide).⁵ Conversely, the macrocyclic GBCAs, gadoterate meglumine, gadobutrol and gadoteridol, have the highest kinetic stability and least propensity to release free Gd³⁺ and, as a group, have been associated with very few unconfounded cases [none with gadoteridol, very few (0.7%) with gadobutrol or gadoterate meglumine].⁵ Based on these observations, the European Medicines Agency (EMA) and UK Medicines and Healthcare Products Regulatory Agency (MHRA) introduced a classification scheme for GBCAs based on observed and perceived risk for NSF.^8,9 Thus, the macrocyclic GBCAs are categorized as low risk for NSF while the non-ionic, open-chain (linear) GBCAs are categorized as high risk. Also included in the category of high-risk agents is gadopentetate dimeglumine because of a comparatively high number of unconfounded NSF cases associated with this agent (approximately 20% of published unconfounded cases⁵).Of particular interest, however, are gadobenate dimeglumine (MultiHance^®; Bracco Imaging SpA, Milan, Italy), gadofosveset trisodium and gadoxetate disodium that are categorized as having intermediate risk for NSF.^8,9 Although these agents are ionic, open-chain GBCAs like gadopentetate dimeglumine, no unconfounded cases of NSF have yet been reported for any of these agents.⁵ The principal molecular difference between these agents and gadopentetate dimeglumine is that each possesses an aromatic group on the contrast-effective molecule, whereas gadopentetate dimeglumine does not.¹⁰ Among the unique features conferred by this aromatic moiety is that each of these three GBCAs are taken up by functioning hepatocytes to a greater or lesser extent and excreted via the hepatobiliary route into the bile and, ultimately, the faeces.^11–20 The degree to which these agents are eliminated via the hepatobiliary route is species dependent. Thus, in human subjects with normal renal and liver function, between 2% and 4% of the injected dose of gadobenate dimeglumine is eliminated by this route, while the remainder is eliminated into the urine via the kidneys.^19,20 Conversely, hepatobiliary elimination of gadobenate dimeglumine in animals has been shown to range between approximately 25% and 55% of the injected dose depending on the species, with rats demonstrating the greatest biliary excretion followed by dogs, rabbits and monkeys.²¹ The possibility to eliminate Gd³⁺ via the hepatobiliary pathway is clearly potentially highly advantageous in patients with severe chronic kidney disease [CKD; Stage 4 or 5 according to the CKD classification of the US National Kidney Foundation;²² glomerular filtration rate (GFR) <30 ml min⁻¹ 1.73 m⁻² or renal failure] or end-stage renal disease who are at risk of developing NSF but who nevertheless require a contrast-enhanced MRI examination for diagnostic purposes.Compensatory elimination of Gd³⁺ has previously been demonstrated in rats with severely impaired liver and kidney function after administration of gadoxetate disodium.²³ The aim of our study was to determine whether compensatory elimination of Gd³⁺ occurs similarly in rats with impaired hepatic or renal function after administration of gadobenate dimeglumine.     

Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later

Purpose

Quadriceps femoris (QF) strength deficits at return-to-sport (RTS) after ACL reconstruction (ACLR) contribute to decreased knee function at the same time point. However, the impact of QF strength at RTS on longitudinal function has not been examined. The purpose of this study was to test the hypothesis that young athletes after ACLR with QF strength asymmetry at RTS would demonstrate decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS compared to young athletes following ACLR with nearly symmetric QF strength at RTS.

Methods

Participants included 76 young athletes (74% female; mean age at RTS = 17.3 years) after primary, unilateral ACLR, cleared to RTS, and followed for 1 year after RTS. At the time of RTS, QF strength was quantified on an isokinetic dynamometer and a Limb Symmetry Index (LSI) was calculated [(involved/uninvolved) × 100%]. The cohort was subdivided into two groups based on RTS QF LSI: high quadriceps (HQ; LSI ≥ 90%; n = 36) and low quadriceps (LQ; LSI < 85%; n = 36). The cohort was followed for 1 year post-RTS, and knee-related function was assessed using the International Knee Documentation Committee subjective form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and LSI of single-leg hop tests. Functional recovery at 1 year post-RTS was defined as KOOS scores above literature-reported cut-offs.

Results

While the HQ group demonstrated higher symmetry on all 1 year post-RTS hop tests, only the triple-hop test (p = 0.020) was found to be statistically different. Similarly, while the HQ group scored higher on all 1 year post-RTS self-reported knee function measures, only differences on the KOOS-Sport/Rec score (p = 0.039) and IKDC score (p = 0.011) were statistically different. Additionally, the HQ group demonstrated higher proportions of functional recovery at 1 year post-RTS than the LQ group on the KOOS-Symptoms (HQ: 88.9%, LQ: 69.4%; p = 0.040) and KOOS-Sport/Rec (HQ: 91.7%, LQ: 69.4%; p = 0.017).

Conclusions

Young athletes after ACLR with QF strength asymmetry at RTS demonstrated decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS. However, group differences did not exceed reported minimal clinically important difference values. Further study is warranted to understand factors that contribute to longitudinal knee function after ACLR. Clinicians should focus on restoring symmetric QF strength at RTS after ACLR, which may promote higher longitudinal knee function.

Level of evidence

Level II, Prospective cohort study.

     

小儿下颌骨髁状突不完全(弯曲?)骨折

小儿下颌骨髁状突骨折并不少见且常合并咬合不良及下颌畸形.但文内出示的不完全弯曲骨折虽有疼痛却很少造成咬合不良。这种骨折较隐蔽,初诊时易漏诊。按受外力大小,骨骼可碎裂或弯曲。当它还没达到发生一个典型的青枝骨折之前,可出现单纯性弯曲。于是仅显中等度的向外弯曲。这种变形最易显于下颌正位象或头颅汤氏位照片上,但在侧     

The Journal of Cardiovascular Computed Tomography year in review – 2019

The purpose of this review is to summarize the work published by the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2019, highlighting original research and new guidelines.     

Estimation of the time since death—reconsidering the re-establishment of rigor mortis

In forensic medicine, there is an undefined data background for the phenomenon of re-establishment of rigor mortis after mechanical loosening, a method used in establishing time since death in forensic casework that is thought to occur up to 8 h post-mortem. Nevertheless, the method is widely described in textbooks on forensic medicine. We examined 314 joints (elbow and knee) of 79 deceased at defined time points up to 21 h post-mortem (hpm). Data were analysed using a random intercept model. Here, we show that re-establishment occurred in 38.5% of joints at 7.5 to 19 hpm. Therefore, the maximum time span for the re-establishment of rigor mortis appears to be 2.5-fold longer than thought so far. These findings have major impact on the estimation of time since death in forensic casework.