Revision risk after pediatric spinal deformity surgery: a nationwide study with 2-year follow-up

BACKGROUND CONTEXTRevision risk after pediatric spine surgery is not well established and varies between deformity etiologies.PURPOSETo report the 2-year revision risk following surgery for primary pediatric spinal deformity in a nationwide cohort and to evaluate potential risk factors and reasons for revision surgery.DESIGNRetrospective nationwide cohort study.PATIENT SAMPLEA national registry study of all pediatric spinal deformity patients undergoing surgery during 2006–2015 (n=1310).OUTCOME MEASURESTwo-year revision risk.METHODSAll patients ≤21 years of age undergoing spinal deformity surgery in Denmark during 2006–2015 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on revision surgery were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for revision in all patients. Potential risk factors for revision were assessed with multiple logistic regression analyses and included age, etiology, sex, Charlson comorbidity index (CCI), and growth-preserving treatment.RESULTSPatients were categorized according to etiology: idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann's kyphosis (5%), and syndromic deformity (3%). Of 1,310 included patients, 9.2% underwent revision surgery within 2 years and 1.5% was revised more than once. Median time to revision was 203 (interquartile range 35–485) days. The multivariable logistic regression found significantly higher odds ratio (OR) for revision in patients with growth-preserving treatment (OR=5.1, 95% confidence interval [CI] 2.6–10.1), congenital deformity (OR=2.7, 95% CI 1.3–5.3), spondylolisthesis (OR=3.5, 95% CI 1.9–6.7), Scheuermann kyphosis (OR=3.9, 95% CI 1.9–8.3), and CCI score ≥3 (OR=2.5 95% CI 1.1–5.6). The most common reason for revision was implant failure (32.5%) followed by residual deformity and/or curve progression (15.8%).CONCLUSIONSIn this nationwide study, the 2-year revision risk after primary pediatric spinal deformity surgery is 9.2%. Risk factors for revision are etiology of congenital deformity, spondylolisthesis, Scheuermann kyphosis as well as patients with growth-preserving treatment and higher CCI. The most common reason for revision is implant failure.     

Being in transit and in transition The experience of time at the place,when living with severe incurable disease ‐ a phenomenological study

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open‐ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.     

Failing Masculinity at the Club: A Poststructural Alternative to Intoxication Feminism

With a starting point in women's studies, this article moves on to approach the nightclub as a place of embodiment for both genders by introducing neo-Lacanian insights combined with Baudrillardian concepts. We look at three young drug-experienced men interviewed for a Danish club study (2008–09). The article examines how the risks of losing masculinity, losing sexual opportunities, and losing friends are managed in nightlife. Since masculinity becomes invested in the fantasy of the drug and the utopian party, these young men can be perceived as risking their male position when the party does not work out as planned.     

Auscultatory versus oscillometric measurement of blood pressure in octogenarians

Abstract Background. Auscultatory measurement using a sphygmomanometer has been the predominant method for clinical estimation of blood pressure, but it is now rapidly being replaced by oscillometric measurement. Objective. To compare blood pressure by auscultatory and oscillometric measurements in patients ≥?80 years. Method. 100 patients had blood pressure measured by auscultation with a sphygmomanometer and by an electronic device using the oscillometric method. For each patient the mean of two blood pressures with each method measured within 15 min were compared. Results. The mean age of participants was 85.8 years; 55.8% were women. The correlation coefficient for systolic blood pressure was 0.88 and for diastolic 0.79. Differences between auscultatory and oscillometric values were less than 10 mmHg in 70.6% of systolic blood pressures and in 83.2% for diastolic. Arrhythmia and hypertension did not influence the results, and there was no correlation between the magnitude of the differences and the level of blood pressure. Conclusion. Agreement between oscillometric and auscultatory measurements of blood pressure in octogenarians was found to be less than required by validation protocols. However, semi-automatic equipment, which is observer-independent, may be used even in the very elderly, particularly if multiple readings are performed.     

Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis

European Spine Journal - The purpose of the present study was to validate a new spinal sagittal classification. We retrospectively included 105 consecutive AIS patients who underwent posterior...     

Independent Origin of Plasmodium falciparum Antifolate Super-Resistance,Uganda, Tanzania,and Ethiopia

Super-resistant Plasmodium falciparum threatens the effectiveness of sulfadoxine–pyrimethamine in intermittent preventive treatment for malaria during pregnancy. It is characterized by the A581G Pfdhps mutation on a background of the double-mutant Pfdhps and the triple-mutant Pfdhfr. Using samples collected during 2004–2008, we investigated the evolutionary origin of the A581G mutation by characterizing microsatellite diversity flanking Pfdhps triple-mutant (437G+540E+581G) alleles from 3 locations in eastern Africa and comparing it with double-mutant (437G+540E) alleles from the same area. In Ethiopia, both alleles derived from 1 lineage that was distinct from those in Uganda and Tanzania. Uganda and Tanzania triple mutants derived from the previously characterized southeastern Africa double-mutant lineage. The A581G mutation has occurred multiple times on local Pfdhps double-mutant backgrounds; however, a novel microsatellite allele incorporated into the Tanzania lineage since 2004 illustrates the local expansion of emergent triple-mutant lineages.     

Use of progestogen-only contraceptives/medications and lipid parameters in women age 40 to 42 years: results of a population-based cross-sectional Norwegian Survey

This population-based cross-sectional study assessed lipid and lipoprotein parameters in women using progestogen-only contraceptives or medications and in those using no hormones. Unselected women about age 40 to 42 years were invited, and the participation rate was 65.6%. A total of 30,636 women were premenopausal, not pregnant, and used either a progestogen [n = 3000, including 2463 users of a intrauterine device (IUD) with levonorgestrel 20 microg/24 h] or no sex hormones. Those using the hormone-releasing IUD reported better health and a healthier lifestyle than nonusers of hormones, while women using depot medroxyprogesterone acetate had a less healthy lifestyle. Compared with nonusers of hormones, users of a levonorgestrel IUD were more likely to have high density lipoprotein (HDL)-cholesterol concentrations < or =1.1 mmol/L (odds ratio 1.4; 95% CI 1.2-1.5), while users of oral norethisterone or lynestrenol, or depot medroxyprogesterone acetate had a doubled to tripled risk of low HDL-cholesterol concentrations. Use of the IUD with levonorgestrel was also linked with a decreased risk of high serum triglycerides and of high non-HDL-cholesterol concentrations and a total/HDL-cholesterol ratio similar to that of nonusers of hormones.