Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020     

Erotic and sadomasochistic foot and shoe*

The foot is an erotic symbol of great power for primitive peoples as well as in highly advanced societies. The foot has always been a badly-treated organ, at the same time an inexhaustible source of contradictory praise and disparagement. The foot and the shoe are inseparable. Since more than 1000 years, the shoe is a sexual symbol and serves as a sexual mode of communication, because it is the cover of the erotic foot. The fetishism of the foot and the shoe has aroused marks of delirious love, always sensual, sometimes mystical. Foot sadomasochism, is a very ancient sexual perversion that consists in taking pleasure in inflicting physical pain to oneself or to others. * Communication submitted: In French, to the CIP International Congress in Buenos Aires (1996); in English, to the BOFSS Congress in Canterbury (2001) Published, in part, in French, in the Encyclopédie Médico-chirurgicale, Podologie, (Elsevier, Paris), 27-140-A-55, 1999,11p     

Transdermal hyoscine and postoperative nausea and vomiting

Forty-two patients, undergoing major gynaecological surgery, were randomly allocated to have a patch applied to the skin behind one ear, containing either hyoscine or placebo. They were followed up at 24-hour intervals for 3 days postoperatively and divided into matched pairs for statistical analysis. There was a significant (p less than 0.01) reduction in nausea and vomiting in the first 24 hours postoperatively, but no difference thereafter. There was an increased incidence of visual disturbance in the hyoscine group at 48 hours, but no other differences in the side effects studied at any other time. However, despite receiving hyoscine there was still a high incidence (68%) of severe nausea and vomiting.     

Pain and opioids in preterm and newborns

Despite the fact that neonates and infants are not capable of expressing their subjective pain sensations, it has become clear that they do perceive nociception, as pain correlates to hormonal, metabolic, immune, and cardiovascular changes. New findings support the notion that repetitive painful stimuli result in long term psycho-physiological effects with ensuing decreased attentiveness and orientation, poor regulation of behavioral state and motor processes, increase in irritability as well as an altered pattern of feeding and sleeping. These sequelae of repetitive painful experiences with an increase in sensitization of sensory afferent input supports the view of a sufficient analgesia during all kinds of painful procedures in the preterm and neonate. In order to sufficiently diminish nociceptive afferent input during surgery opioids are the drugs of choice aside from local anesthetics. However, the use of opioids in neonates and especially preterm infants must be considered in the light of certain pharmacokinetic and pharmacodynamic differences when compared to adults: 1. There is a longer elimination rate, which may result in post-operative overhang of respiratory depression, especially when opioids are given repetitively, resulting in an accumulation and an increased duration of action. 2. There is a reduced hepatic enzyme activity, which ultimately affects clearance rate. 3. The blood-brain-barrier is not fully developed in the preterm, which results in more access of opioids to binding sites in the CNS. 4. Differentiation of opioid-binding sites into mu, delta, and kappa has not reached its peak; thus, higher doses relative to body weight are needed to establish a sufficient deep plane of analgesia. 5. Caudal parts of the CNS, especially the pons-medullar region exhibit an earlier expression of receptors than the rostral parts. Sequelae of such differences are a more pronounced respiratory depression, often due to muscular rigidity, and bradycardia after which a full analgesic effect takes place. Despite such potential drawbacks, opioids are still the best choice as they sufficiently block nociceptive afferent input and when compared to other anesthetics, they show the least cardiovascular changes. One, however, has to bear in mind that dosing is done according to effect and not to body weight while potential side effects are most prominent in the preterm infant.     

Urodynamic evaluation and electrical and pharmacologic neurostimulation

Summary We introduce a rat model that allows simultaneous or independent recording of bladder and sphincteric activity. Via a polyethylene tube inserted into the bladder dome, bladder pressure is measured in response to constant intravesical saline perfusion. The electrical activity of the intra-abdominal urethra (a well-defined striated muscular tube which, in the rat, constitutes the external urethral sphincter) is recorded simultaneously with an electromyography needle electrode. Thus, precise statements can be made about detrusor/sphincter interrelationships. Changes in urodynamic parameters with the anesthetics urethane, methoxyflurane (Metofane), and thiobutabarbital sodium (Inactin) were investigated. High-frequency oscillations in intraluminal bladder pressure could be demonstrated during micturition cycles only in rats anesthetized with urethane or Metofane. As this high-frequency activity is generated by the striated muscle of the intra-abdominal urethra, the external sphincter of the rat is the force behind urine expulsion. The anesthetic Inactin combined with a low intravesical perfusion rate attenuated spontaneous bladder and sphincteric activity and abolished micturition cycles. This rat model can provide accurate and reproducible measurements of urodynamic changes in response to electrical stimulation of the pelvic and pudendal nerves and pharmacologic stimulation with neuropeptides at the lumbosacral spinal cord level. We recommend using this model with urethane or Metofane for physiologic studies of micturition and with Inactin for meticulous neuropharmacologic and electrostimulatory evaluation of urodynamic parameters.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

腹腔镜与开腹阑尾切除术的比较分析

目的:分析比较腹腔镜与开腹阑尾切除术(open appendectomy,OA)的临床效果。方法:回顾分析60例腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和同期OA组60例的手术资料,比较两组手术时间、腹腔内其他病变探查率、术后肛门排气时间、术后下床时间、住院费用、术后止痛剂使用、切口感染、粘连性肠梗阻、腹腔残余感染发生率等指标。结果:LA组的腹腔内其他病变探查率、术后肛门排气时间、术后下床时间、术后止痛剂使用、切口感染发生、粘连性肠梗阻、腹腔残余感染情况与OA组比较,差异均有统计学意义(P<0.01)。手术时间、住院费用两组差异无统计学意义(P>0.05)。结论:LA与OA相比具有创伤小、恢复快、住院时间短、美容等优点。在无禁忌证的情况下,可推荐患者行LA。     

椎体成形术和后凸成形术:充填材料和生物力学

经皮椎体成形术(PVP)和后凸成形术(PKP)是在影像装置引导下，将骨水泥通过椎弓根途径注入压缩骨折或破坏的椎体内，目的是止痛和稳定、重建病变椎体，具有微创、并发症低等优点，PKP还有增加椎体高度的作用。本文综述了不同充填材料的体外生物力学实验结果，并对这些结果进行了对比分析和讨论。评价了不同充填材料、不同充填量以及材料在椎体内的分布等对椎体生物力学性能的影响，指出了目前PVP和PKP存在的问题和今后在手术操作、充填材料等方面发展的方向。