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Aim: To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate-specific antigen levels. Methods: Seventy-six men with a mean age of 57.04 ± 9.27 years (range 44–77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed. Results: The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28 ± 1.13 ng/mL and 1.11 ± 0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P = 0.519). In Group I, postoperative means were 4.96 ± 6.29 ng/mL and 5.86 ± 9.09 ng/mL in the first and fifth days, respectively (P = 0.0001, P = 0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13 ± 2.72 ng/mL and 2.00 ± 2.20 ng/mL, respectively (P = 0.014, P = 0.024). The comparison of total postoperative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P = 0.013; day 5: P = 0.05). Conclusions: Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization.

Background: The accurate diagnosis of musculoskeletal tumours is important for successful treatment. Image guided biopsy is gaining increasing acceptance for obtaining tissue for diagnosis. The aim of the present study is to assess the accuracy of computed tomography (CT)-guided core needle biopsy of musculoskeletal tumours. Methods: This is a retrospective study on a series of 127 patients with a musculoskeletal tumour. The biopsies were performed over a 4-year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to distinguish between a benign and malignant tumour. Results: Computed tomography guided core needle biopsy in the present series has an overall accuracy of 80.3%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81.4% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 98.9% and the PPV of benign tumour 90.2%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n = 12), osteosarcoma (n = 11) and giant cell tumour (n = 11). There were no reported complications arising from the biopsy. Conclusion: Computed tomography guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours. It should be performed in a specialized institution with a multidisciplinary musculoskeletal tumour team.

Aim The aim of this study is to determine the short-term outcome of lateral unicompartmental knee arthroplasty (UKA) using a domed tibia, mobile bearing prosthesis. The primary outcome measure was revision due to bearing dislocation and the secondary measure was functional outcome. Methods From 2005 to 2009, a total of 64 knees, in 58 patients, were identified as having the domed tibia, mobile bearing lateral UKA with a minimum 2-year follow-up. Forty-one females and 17 males with a mean age of 71years (range 44 to 92, median 72) were reviewed. The mean follow-up period was 38months (range 24 to 61, median 36). The primary outcome measure was re-operation and revision rate, particularly due to bearing dislocation. The secondary outcome assessed was a patient reported outcome measure (PROM) using the Oxford Knee Score (OKS) and compared using Student's Paired T -test. Results There were four knees that underwent further surgery for any reason. Two patients required revision of the implant (3.1%). There were no cases of bearing dislocation in this series. The mean pre-operative OKS was 24 (range 9 to 36) and the mean post-operative score was 42 (range 23 to 48 p Conclusion This study from an independent centre, reporting on the short-term results of the domed tibia, mobile bearing lateral UKA supports the safety and efficacy of the procedure as a treatment option in the patients with lateral compartment osteoarthritis (OA) of the knee. Level of evidence This is a level 4; case series study.

To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate-specific antigen levels.Seventy-six men with a mean age of 57.04+/-9.27 years (range 44-77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed.The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28+/-1.13 ng/mL and 1.11+/-0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P=0.519). In Group I, postoperative means were 4.96+/-6.29 ng/mL and 5.86+/-9.09 ng/mL in the first and fifth days, respectively (P=0.0001, P=0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13+/-2.72 ng/mL and 2.00+/-2.20 ng/mL, respectively (P=0.014, P=0.024). The comparison of total postoperative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P=0.013; day 5: P=0.05).Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization.

Divergent dislocation of the elbow is defined as a specific elbow dislocation in which the distal humerus is forced between the proximal radius and ulna, resulting in separation or divergence of the proximal forearm bones. This is an uncommon injury in children, with 14 cases reported in the last 23 years. The authors report three additional cases and the findings from cadaver elbow dissections in which the injury was reproduced. The authors propose that there is only one type of divergent dislocation, resulting from indirect forces transmitted to the elbow from a fall on the outstretched hand. The injury predominantly occurs in younger children because joint laxity is a predisposing cause. Early recognition, followed by a closed reduction and a 3- to 4-week period of cast immobilization, should result in a full recovery for most children.

The distributions of inorganic nutrients and phytoplankton chlorophyll-a were investigated in relation to the hydrography of the Aegean Sea. The data were collected during cruises in May and October 1992, February, May and October 1993 and July 1994, in the framework of a National Marine Measurement and Monitoring Programme for the Aegean Sea. Concentrations of nitrate +nitrite+ammonia nitrogen and phosphate phosphorus were lower than those previously reported for the Black Sea; generally lowest at the surface, they increased with depth. The highest nutrient values were in the northern part of the Aegean Sea, and may have resulted from water originating from the Black Sea. Both phosphates and silicates increased with depth to maxima of 0.16 and 4.7 mu M, respectively. The concentration of chlorophyll-a ranged from 0.03 to 0.70 mg m(-3). Elemental ratios (N/P and Si/P) were calculated to be 13.6 - 36.8 and 14.0 - 48.0, respectively.

Background Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle–tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. Methods We performed a randomized trial on paired cadaver tibialis posterior muscle–tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron® machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. Results We found 48% greater lengthening for low IMT compared to high IMT for a given load ( P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. Conclusions Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical “dose” by altering the position of the intramuscular tenotomy within the muscle–tendon-unit.

Nonalcoholic fatty liver disease (NAFLD) refers to excess fat accumulation in the liver. In animal experiments and human kinetic study, we found that administration of combined metabolic activators (CMAs) promotes the oxidation of fat, attenuates the resulting oxidative stress, activates mitochondria, and eventually removes excess fat from the liver. Here, we tested the safety and efficacy of CMA in NAFLD patients in a placebo‐controlled 10‐week study. We found that CMA significantly decreased hepatic steatosis and levels of aspartate aminotransferase, alanine aminotransferase, uric acid, and creatinine, whereas found no differences on these variables in the placebo group after adjustment for weight loss. By integrating clinical data with plasma metabolomics and inflammatory proteomics as well as oral and gut metagenomic data, we revealed the underlying molecular mechanisms associated with the reduced hepatic fat and inflammation in NAFLD patients and identified the key players involved in the host–microbiome interactions. In conclusion, we showed that CMA can be used to develop a pharmacological treatment strategy in NAFLD patients., A placebo‐controlled human study shows that oral administration of Combined Metabolic Activators (CMA) reduces liver fat in nonalcoholic fatty liver disease (NAFLD) patients.