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ObjectiveLiver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM-VCTE), Fibrosis-4 Index (FIB-4) and NAFLD (non-alcoholic fatty liver disease) Fibrosis Score (NFS) and to derive diagnostic strategies that could reduce the need for liver biopsies.DesignIndividual patient data meta-analysis of studies evaluating LSM-VCTE against liver histology was conducted. FIB-4 and NFS were computed where possible. Sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Biomarkers were assessed individually and in sequential combinations.ResultsData were included from 37 primary studies (n=5735; 45% women; median age: 54 years; median body mass index: 30 kg/m2; 33% had type 2 diabetes; 30% had advanced fibrosis). AUROCs of individual LSM-VCTE, FIB-4 and NFS for advanced fibrosis were 0.85, 0.76 and 0.73. Sequential combination of FIB-4 cut-offs (ConclusionSequential combinations of markers with a lower cut-off to rule-out advanced fibrosis and a higher cut-off to rule-in cirrhosis can reduce the need for liver biopsies.

INTRODUCTION: The overall effectiveness of supervised progressive resistance training among patients with hip osteoarthritis is only scarcely investigated. The objective of this study was to estimate the effectiveness of supervised progressive resistance training compared with common treatment for patients with hip osteoarthritis, focusing on patient-reported function, pain, health-related quality of life, performance-based function at end of treatment and patient-reported function at 6-12 months.METHODS: This was a systematic review and meta-analysis. A systematic search was performed on 30 January 2019 in eight electronic databases (Medline, Embase, Cochrane, Pedro, AMED, Scopus, SPORTDiscus and Cinahl). The methodology of the included studies and the overall quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation approach.RESULTS: A total of 189 participants with hip osteoarthritis > 50 years of age were included in the three studies. A significant difference in favour of the supervised progressive resistance groups was found in patient-reported function (weighted mean difference (MD) = 9.13 (95% confidence interval (CI): 4.45-13.80)), hip-related pain (weighted MD = 7.83 (95% CI: 2.64-13.02)) and health-related quality of life (weighted MD = 6.80 (95% CI: 1.96-11.63)) at end of treatment. The overall quality of evidence was downgraded to low due to a lack of blinding in the included studies and due to imprecision.CONCLUSIONS: Supervised progressive resistance training might be of clinical relevance for patients with hip osteoarthritis and was effective in improving patient-reported function, hip-related pain and health-related quality of life. The level of evidence is low and future studies may therefore affect the findings reported herein.

Load carrying components of modern wind turbine blades are manufactured from composites, consisting of non-crimp fabrics infused with polymer resins. The effective stiffness of the resulting laminate is a combination of the properties of its building blocks i.e. fibers, and matrix as well as from the fabric texture imperfections e.g. fiber undulations. Moreover, ply inherent boundary conditions, e.g. the restriction of the Poisson deformation of the matrix imposed from the adjacent fibers, are determining the in-situ orthotropic performance. Towards modelling the in-plane stiffness of a unidirectional (UD) infused non-crimp fabric, a two-step modular procedure is proposed, accounting for the aforementioned parameters, based only on experimental data and analytical formulations. Initially, a micromechanical model is predicting the stiffness of the ideal UD ply i.e. disregarding fiber undulations. Subsequently, a plate model is generated based on the classical lamination theory, approximating the UD laminate as a multiaxial configuration of ideal UD sub-plies. Each sub-ply thickness and orientation is based on the fiber angle density distribution of dry fabrics and cured laminates. These are derived experimentally with an integrated optical camera system and Computer Tomography scans respectively. The theoretical laminate stiffness is correlating very well with standard and thick UD laminate quasi-static tests.

BACKGROUND:Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement (THR).AIM:To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR.DESIGN:Non-randomized, controlled study.SETTING:Inpatient.POPULATION:365 consecutively included THR patients.METHODS:Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a standard package of assistive devices (restricted group). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were completed before THR, 3 and 6 weeks after.RESULTS:The HOOS function score at the 3 measurement times was (mean ± SD); unrestricted group: 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group: 43 ± 16 - 81 ± 14 - 83 ± 13. Changes over time was significantly higher in the restricted group (P=0.004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction.CONCLUSION:This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work.CLINICAL REHABILITATION IMPACT:It is possible to reduce movement restrictions and use of assistive devices considerably. More research on safety issues is needed to elucidate the effect of unrestricted rehabilitation on hip dislocation.

The effect of sucrose intake versus a sucrose-free diet (substituting glucose for sucrose) on numbers of isolates from early dental plaque expressing extracellular carbohydrate metabolizing enzymes was studied. The bacteria were isolated from 0- to 3-day-old dental plaque formed on the buccal surface of a lower premolar in 6 subjects. A total of 7,987 isolates were tested for the following activities: synthesis of glucan from sucrose, glucanase, fructanase, synthesis of polymers from glucose, and amylase. Sucrose intake was associated with relatively low numbers of isolates expressing the enzyme activities studied at the start of plaque formation and relatively high numbers in 2- and 3-day plaque. The enzyme activities studied are important elements in the pathophysiology of dental caries and may even be addressed as virulence factors.

Udgivelsesdato: NOV 1

not Available.

Introduction: Gamma knife radiosurgery (GKR) has shown promising results in the treatment of intraocular uveal melanoma (UM) in terms of local tumor control. However, GKR is not free from potentially sight-threatening side effects, including cataract, dry eye disease, vitreous hemorrhage, radiation retinopathy (RR), radiation maculopathy (RM), optic neuropathy, and neovascular glaucoma. The aim of this paper is to report our 20-year experience in UM management with GKR focusing on the rate of clinical treatment-induced complications. Methods: Single-center, retrospective, observational study, including all patients with UM treated at the Ocular Oncology and Uveitis Service, in the Department of Ophthalmology of the San Raffaele Scientific Institute, Milan from September 1993 to September 2018. Clinical charts comprised complete ophthalmological examination with measurement of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, gonioscopy, and indirect ophthalmoscopy at each visit. B-scan ultrasound (Aviso S, 10 MHz probe; Paris, France), optical coherence tomography (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), retinography, and fundus fluorescein angiography (standard or ultra-widefield [UWF; California, Optos, Dunfermline, Scotland, UK]) were performed aiding in the diagnosis of complications. Results: Overall, 194 patients (100 males, 51.6%) were reviewed. The median age at the time of the treatment was 65 years (range 27–89) and all participants were Caucasian. In 185 eyes (95.4%), the tumor was primarily located at the choroid. The median follow-up was 57.6 months; radiation-induced complications were found in 145 eyes (74.7%). Radiation-induced cataract and RR were the most frequent events, with a relative incidence of 41.2 and 34.5%, respectively, followed by neovascular glaucoma (27.3%), optic neuropathy (18.6%), RM (11.4%), vitreous hemorrhage (14.4%), phthisis bulbi (7.7%), hyphema (0.5%), and corneal melting (0.5%). The shorter onset of side effects involved the optic nerve (median 14.9 months) and the macula (median 13.7 months). Conclusion: Despite modern and advanced strategies introduced to limit GKR side effects, cataract and RR still represent a serious limitation of this treatment. Incidence of RR was higher in our cohort compared to other reports, probably due to increased diagnosis rate permitted by UWF retinal imaging.

The field of haematopathology is rapidly evolving and for the non-specialized pathologist receiving a specimen with the possibility of a lymphoid malignancy may be a daunting experience. The coincidence of the publication, in 2017, of the WHO monographies on head and neck and haematopoietic and lymphoid tumours prompted us to write this review. Although not substantially different from lymphomas elsewhere, lymphomas presenting in this region pose some specific problems and these are central to the review. In addition, differences in subtype frequency and morphological variations within the same entity are discussed. The difficulty in diagnosis related to some specimens led us to briefly mention common subtypes of systemic lymphomas presenting in the head and neck region.

Simulations of kink band formation in fiber reinforced composites are carried out using the commercial finite element program ABAQUS. A smeared-out, plane constitutive model for fiber reinforced materials is implemented as a user subroutine, and effects of fiber misalignment on elastic and plastic deformation are studied under plane strain conditions. Simulations of kink band formation in fiber reinforced composites are carried out using the commercial finite element program ABAQUS. A smeared-out, plane constitutive model for fiber reinforced materials is implemented as a user subroutine, and effects of fiber misalignment on elastic and plastic deformation are studied under plane strain conditions.