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The improvement is due to a new way to pass the threads deeply on the bone, using permanent barbed sutures. This surgery becomes easier and more efficient.

Opioid dependence increases risk of premature mortality. Opioid substitution therapy with methadone or buprenorphine reduces mortality risk, especially for drug-related overdose. Clinical guidelines recommend methadone as the first line of opioid substitution therapy. We aimed to test whether buprenorphine treatment has a lower mortality risk than does methadone treatment by comparing all-cause mortality and drug-related overdose mortality at treatment induction, after in-treatment medication switches, and following treatment cessation.

We did a retrospective cohort study of all patients with opioid dependency (n=32,033) in New South Wales, Australia, who started a methadone or buprenorphine treatment episode from Aug 1, 2001, to Dec 31, 2010, including 190,232·6 person-years of follow-up. We compared crude mortality rates (CMRs) for all-cause and drug-related overdose mortality, and mortality rate ratios (MRRs) according to age, sex, period in or out of treatment, medication type, and in-treatment switchbuprenorphine to methadone or for switches to either medication beyond the first 4 weeks of treatment.

In a setting with high risk of death in the first 4 weeks of opioid substitution therapy, buprenorphine seemed to reduce mortality in this period, but little difference between buprenorphine and methadone was noted thereafter or for in-treatment switching of medications. Cross-cohort corroboration of our findings and further assessment of the stepped treatment model is warranted.

Australian National Health & Medical Research Council.

Australian National Health & Medical Research Council.

Group B Streptococcus (GBS) is a leading cause of neonatal morbidity and mortality. In an effort to reduce the impact of this serious affliction, universal screening for GBS has been adopted in many countries. The objective of this study was to examine the acceptability of self-collected GBS swabs in a local population in Hong Kong.

This study is a cross-sectional questionnaire survey conducted in a tertiary teaching hospital. A total of 327 pregnant women who attended the antenatal clinic for GBS screening from April 2012 to May 2012 were included in our study. The acceptability of GBS self-screening and its associated factors were analyzed.

Of these women, 200/320 (62.5%) participants preferred screening by healthcare workers, whereas only 18/320 (5.6%) preferred self-screening. The most common reasons why some participants preferred to be screened by clinicians were that professionals had greater knowledge, and the added worry about the accuracy of self-screening. 22/320 (69.4%) and 195/320 (60.9%) wpulation still preferred physician-collected samples for GBS screening, but they welcomed the option of self-screening in future pregnancies. Improved health education about the importance of GBS screening may improve the willingness of women to perform self-screening.

Sexual dysfunction (SD) is a common but often overlooked and undertreated symptom in multiple sclerosis (MS). The purpose of our longitudinal study was to explore the changes in the level of sexual functioning in MS cohort after a period of 3 and 6 years of follow-up, as well as to investigate the predictors of changes in SD during the period of observation.

The study population comprise a cohort of 93 patients with MS (McDonald's criteria, 2001) who were assessed at three time points during the study (baseline, and at the 3- and 6-year follow-up). The presence and severity of SD was quantified by Szasz sexual functioning scale. Independent predictors of the ordinal-scaled measure of sexual problems were identified using a generalized linear mixed regression models.

The number of reported SD symptoms increased markedly for both genders during the whole period of observation. Duration of follow-up, age, level of physical disability, depression and fatigue were identified as independent prognostic factors for deterioration of sexual functioning in patients with MS during the 6-year follow-up.

Our study provides insight into dynamics of change in sexual function among patients with MS and predictors of change, over the period of 6 years.

Our study provides insight into dynamics of change in sexual function among patients with MS and predictors of change, over the period of 6 years.

Amyotrophic Lateral sclerosis (ALS) is associated with a significant distress, being linked to changes in hypothalamic-pituitary-adrenal axis activity. A loss of cortisol circadian rhythmicity in ALS patients was suggested,while more recently an increased plasma cortisol level in the disease has been reported.

To assay the circadian plasma cortisol level in ALS and to study its relationship with the clinical phenotype and the rate of disease progression.

135 ALS patients (Bulbar, 33; Spinal, 102;M/F=1.73) and 110 controls (not affected by neurological or psychiatric disorders, free of drugs; M/F=1.75) were recruited. Disease progression was scored with ΔFS.Morning and evening plasma cortisol levels (μg/dl)were assayed from fasting ALS patients and controls using Elecsys® Cortisol Immunoassay System.

We found that the morning level of cortisol in ALS patients was higher than controls (morning ALS, 15.2[11.5-18.9] vs Controls, 11.4 [8.8 -14.3], p b 0.001; evening ALS, 7.5[4.7–11.8] vs Controls, 7.9[5.4–10.0], p=0.6).Furthermore, the hormone's level was higher in the spinal-onset group (Spinal, 15.9[11.9–19.0] vs Bulbar,13.5[10.1–18.6] vs controls, 11.4[8.8–14.3], p b 0.001) and in patients with intermediate/rapid disease course.

Morning plasma cortisol level is increased in ALS, mainly in spinal-onset patients and in those with intermediate/rapidly progressing disease. The plasmatic changes of the steroid hormone appear however too small to make it a sensitive biochemical marker in this severe neurodegenerative disease.

Morning plasma cortisol level is increased in ALS, mainly in spinal-onset patients and in those with intermediate/rapidly progressing disease. The plasmatic changes of the steroid hormone appear however too small to make it a sensitive biochemical marker in this severe neurodegenerative disease.

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease that progresses to axonal loss and demyelinization. Olfactory dysfunction in patients with MS has been reported frequently. We were interested in the associations of olfactory bulb (OB) and olfactory sulcus depth (OSD) with disease duration and attack frequency.

We included 25 patients with MS and 30 age- and sex-matched controls in this study. The Expanded Disability Status Scale, Beck Depression Inventory, and Mini Mental State Examination were applied. OB, OSD, and magnetic resonance imaging plaque numbers were calculated.

OB volume and OSD in patients with MS were significantly lower than those in the control group (right and left OB p<0.001; right OSD p=0.001; and left OSD p=0.039). Disease duration was negatively correlated with right and left OB volume (right OB r=-0.434, p=0.030 and left OB r=-0.518, p=0.008). Attack frequency was negatively correlated with left OB volume and left OSD (left OB r=-0.428, p=0.033 and left OSD r=-0.431, p=0.032).

The OB and OSD were atrophied significantly in patients with MS, and this was correlated with disease duration and attack frequency. The left side tended to be dominant.

The OB and OSD were atrophied significantly in patients with MS, and this was correlated with disease duration and attack frequency. The left side tended to be dominant.

To analyze the texture features on cranial sonography in preterm neonates with white matter injury quantitatively and to correlate these features with magnetic resonance imaging (MRI).

The study included 33 preterm neonates treated in our neonatal intensive care unit who underwent serial cranial sonography and brain MRI near term. Patients were subdivided into 3 groups according to the presence and severity of white matter injury as revealed by MRI normal (group 1; n = 20), mild (group 2; n = 5), and severe (group 3; n = 8). The periventricular echogenicity on sonography was evaluated quantitatively with second-order gray-level statistics (gray-level co-occurrence matrix [GLCM] method). Four GLCM texture features representing homogeneity were extracted in 12 directions (1) angular second moment (ASM), (2) inverse differential moment (IDM), (3) contrast, and (4) entropy.

Thirty of 48 features showed a statistically significant difference between groups 1 and 3 (ASM in 9 directions, IDM in 6 directions, contrast in 3 directions, and entropy in all 12 directions). There were no significant differences observed between groups 1 and 2 or groups 2 and 3. The mean contrast and entropy values were generally lower in group 1 than group 3, whereas the mean ASM and IDM values were higher in group 1.

Severe white matter injury could be identified by using GLCM texture analysis, whereas mild white matter injury observed on MRI could not be evaluated by GLCM analysis. selleck products Quantitative texture analysis using the GLCM may serve as a complementary tool for quantitative assessment of periventricular echogenicity.

Severe white matter injury could be identified by using GLCM texture analysis, whereas mild white matter injury observed on MRI could not be evaluated by GLCM analysis. Quantitative texture analysis using the GLCM may serve as a complementary tool for quantitative assessment of periventricular echogenicity.

The purpose of this study was to evaluate the normal thickness of the filum terminale on sonography and suggest an optimal cutoff value for filum terminale lipoma screening in young children.

We retrospectively reviewed lumbosacral sonograms and magnetic resonance images from children younger than 36 months that were obtained between January 2013 and June 2014. The filum terminale thickness on sonography and the presence of fat in the filum terminale on magnetic resonance imaging were evaluated.

From 111 children (mean age ± SD, 3.6 ± 3.0 months), 49 did not have abnormal lesions (normal group), and 62 had fat infiltration in the filum terminale (lipoma group). The filum terminale was thicker in the lipoma group than the normal group (1.5 ± 0.5 versus 0.9 ± 0.2 mm; P < .001). Filum terminale thickness also showed significance in a multivariable analysis with sex and age (odds ratio per 0.1-mm unit, 2.754; P < .001) and in propensity score matching for age (P < .001). The optimal cutoff value for filum terminale lipoma screening was 1.1 mm, with 94% sensitivity and 86% specificity.

The conventional cutoff value of 2 mm for a thickened filum terminale on sonography can be too thick. We suggest an optimal cutoff value of 1.1 mm for lipoma screening in young children.

The conventional cutoff value of 2 mm for a thickened filum terminale on sonography can be too thick. We suggest an optimal cutoff value of 1.1 mm for lipoma screening in young children.

To investigate normal liver stiffness and its influential factors in adults without liver disease using real-time tissue elastography. The liver stiffness threshold value for identifying patients with chronic liver disease was also determined.

One hundred twenty healthy volunteers were examined with real-time tissue elastography. An integrated quantitative elastographic parameter, defined as the liver fibrosis index, was obtained by tissue dispersion quantitative analysis. Correlations between the liver fibrosis index and age, sex, and body mass index (BMI) were studied. To determine the threshold value for identifying chronic liver disease, 29 patients with chronic hepatitis B who underwent liver biopsy, including patients without fibrosis (fibrosis stage F0; n = 9) and patients with substantial fibrosis (F1-F2; n = 20) were also investigated. A receiver operating characteristic curve analysis for differentiating the F0 from the F1-F2 group was performed.

There were no significant differences in the mean liver fibrosis index between sexes or among different age groups.