Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes?

Type 1 diabetes(T1D)is associated with general-and diabetes-specific stress which has multiple adverse effects.Hence measuring stress is of great importance.An algometer measuring pressure pain sensitivity(PPS)has been shown to correlate to certain stress measures in adults.However,it has never been investigated in children and adolescents.The aim of our study was to examine associations between PPS and glycated hemoglobin(HbA1c),salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D.Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits.Salivary cortisol,PPS and questionnaires were collected,measured,and answered on site.HbA1c was collected from medical files.We found correlations between PPS and HbA1c(rho=0.35,P=0.046),cortisol(rho=-0.25,P=0.02)and Perceived Stress Scale(rho=-0.44,P=0.02)in different subgroups based on age.Males scored higher in PPS than females(P<0.001).We found PPS to be correlated to HbA1c but otherwise inconsistent in results.High PPS values indicated either measurement difficulties or hypersensibility towards pain.

Increasing Incidence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL) and the Relation to Consumption of Broad-Spectrum Antimicrobial Agents 2003-2011 in a Large Area of Copenhagen, Denmark

Purpose: To investigate 1) the development in the incidence of ESBL-producing bacteria in hospitals and primary health care, 2) the contribution of primary health care to the incidence of ESBL-producing bacteria, and 3) the development in resistance patterns for all Escherichia coli and Klebsiella pneumoniae isolates in relation to antimicrobial consumption in hospitals and primary health care. Methods: ESBL-data were retrospectively collected from bacterial isolates from all specimens received at the Department of Clinical Microbiology from 2003 to 2011 together with the corresponding patient data. ESBL-production was detected in isolates from 1067 of 59,373 patients (1.8%) with an E. coli infection and in 263 of 8660 patients (3.0%) with a K. pneumoniae infection. Results: From 2003 to 2009, an increase in patients with an ESBL-producing isolate occurred in both hospitals and primary health care at the same time as an increased consumption of broad-spectrum antimicrobial agents was seen. Interventions to reduce prescription of cephalosporins and ciprofloxacin at the hospitals from 2010 resulted in a remarkable decrease in patients with ESBL-producing K. pneumoniae whereas a continuing increase was seen in patients with ESBL-producing E. coli both at hospitals and in primary health care. The proportion of patients with community-acquired ESBL-producing E. coli was stable with an increase of only 1.4% from 2007 to 2011. Conclusions: Reduction in prescription of broad-spectrum antimicrobial agents at the hospital level had an important impact on the incidence of ESBL-producing K. pneumoniae, but not on ESBL-producing E. coli.

Fecal microbiota transplantation for the treatment of irritable bowel syndrome:A systematic review and meta-analysis

BACKGROUND Irritable bowel syndrome(IBS)is the most prevalent gastrointestinal disorder in developed countries and reduces patients’quality of life,hinders their ability to work,and increases health care costs.A growing number of trials have demonstrated an aberrant gut microbiota composition in IBS,also known as‘gut dysbiosis’.Fecal microbiota transplantation(FMT)has been suggested as a treatment for IBS.AIM To assess the efficacy and safety of FMT for the treatment of IBS.METHODS We searched Cochrane Central,MEDLINE,EMBASE and Web of Science up to 24 October 2022 for randomised controlled trials(RCTs)investigating the effectiveness of FMT compared to placebo(including autologous FMT)in treating IBS.The primary outcome was the number of patients with improvements of symptoms measured using a validated,global IBS symptoms score.Secondary outcomes were changes in quality-of-life scores,non-serious and serious adverse events.Risk ratios(RR)and corresponding 95%CI were calculated for dichotomous outcomes,as were the mean differences(MD)and 95%CI for continuous outcomes.The Cochrane risk of bias tool was used to assess the quality of the trials.GRADE criteria were used to assess the overall quality of the evidence.RESULTS Eight RCTs(484 participants)were included in the review.FMT resulted in no significant benefit in IBS symptoms three months after treatment compared to placebo(RR 1.19,95%CI:0.68-2.10).Adverse events were reported in 97 participants in the FMT group and in 45 participants in the placebo group(RR 1.17,95%CI:0.63-2.15).One serious adverse event occurred in the FMT group and two in the placebo group(RR 0.42,95%CI:0.07-2.60).Endoscopic FMT delivery resulted in a significant improvement in symptoms,while capsules did not.FMT did not improve the quality of life of IBS patients but,instead,appeared to reduce it,albeit non significantly(MD-6.30,95%CI:-13.39-0.79).The overall quality of the evidence was low due to moderate-high inconsistency,the small number of patients in the studies,and imprecision.CONCLUSION We found insufficient evidence to support or refute the use of FMT for IBS.Larger trials are needed.

Hereditary polyposis syndromes remain a challenging disease entity:Old dilemmas and new insights

In this editorial we present an overview and insights of the management of hereditary polyposis syndromes.The primary focus was on familial adenomatous polyposis,juvenile polyposis syndrome and Peutz-Jegher syndrome.Genetic testing has become increasingly available and is easier than ever to integrate into clinical practice.Furthermore,several genes have been added to the expanding list of genes associated with hereditary polyposis syndromes,allowing for precise diagnostics and tailored follow-up.Endoscopic evaluation of patients with hereditary polyposis syndromes is paramount in the surveillance strategies.Current endoscopic procedures include both diagnostic procedures and surveillance as well as therapeutic interventions.Recommendations for endoscopic procedures in the upper and lower gastrointestinal canal were described.Surgery is still a key component in the management of patients with hereditary polyposis syndromes.The increased cancer risk in these patients often render prophylactic procedures or intended curative procedures in the case of cancer development.Surgical interventions in the upper and lower gastrointestinal canal were described with relevant considerations.Development of chemopreventive medications is ongoing.Few drugs have been investigated,including nonsteroidal anti-inflammatory drugs.It has been demonstrated that cyclooxygenase-2 inhibitors may lower the number of polyps.Other medications are currently under investigation,but none have,to date,consistently been able to prevent development of disease.

Nitrogen transformation processes in soil along a High Arctic tundra transect

Soil nitrogen(N)transformation processes in the High Arctic tundra are poorly understood even though nitrogen is one of the main limiting nutrients.We analyzed soil samples collected along a High Arctic tundra transect to investigate spatial variability in key nitrogen transformation processes,functional gene abundances,ammonia-oxidizing archaea(AOA)community structures,and key nitrogen transformation regulators.The potential denitrification rates were higher than the nitrification rates in the soil samples,although nitrification may still regulate N2O emissions from tundra soil.The nutrient(total carbon,total organic carbon,total nitrogen,and NH_(4)^(+)-N)contents were important determinants of spatial variability in the potential denitrification rates of soil along the tundra transect.The total sulfurcontent was the main variable controlling potential nitrification processes,probably in association with sulfate-reducing bacteria.The nitrate content was the main variable affecting potential dissimilatory nitrate reduction to ammonium.AOA and ammonia-oxidizing bacteria amoA,nirS,and anammox 16S rRNA genes were found in all of the soil samples.AOA play more important roles than ammonia-oxidizing bacteria in soilnitrification.Anammox bacteria may utilize NO_(2)^(-)produced through nitrification.Phylogenetic analysis indicated that the AOA amoA sequences could be grouped into eight unique operational taxonomic units(OTUs)with a 97%sequence similarity and were affiliated with three group 1.1b Nitrososphaeraclusters.The results indicated that heterogeneous environmental factors(e.g.,the carbon and nitrogen contents of soil)along the High Arctic tundra transect strongly affected the nitrogen transformation rate and relevant functional gene abundances in soil.

Dermatofibrosarcoma Protuberans—An Atypical Breast Tumor

A 49-year-old woman was referred to the Department of Plastic and Breast Surgery under suspicion of breast cancer after a mammogram revealed a self-discovered tumor in the lower part of her left breast. Clinical examination, mammography, and histopathological examination revealed that the original tumor in the left breast was benign, and an incidental malignant tumor, a dermatofibrosarcoma protuberans (DFSP), was found in the contralateral breast. DFSP is a rare and highly malignant entity that is often silent and difficult to diagnose, making a biopsy essential. Surgical treatment must be aggressive due to the high risk of recurrence, which constitutes a technical challenge. The patient underwent surgery using an oncoplastic approach with a volume-reducing technique to achieve the best possible therapeutic and aesthetic results. Therapeutic breast reduction was performed on the right breast and the tumor was removed within the resected tissue. A contralateral symmetrizing mammoplasty was also performed simultaneously. The patient was discharged without major complications, and no recurrence of the tumor was seen during the 30-month follow-up period. The surgical approach included alternative solutions in addition to conventional lumpectomy or mastectomy. A multidisciplinary, open-minded, and creative approach resulted in a satisfying outcome for this patient.

青少年类风湿性关节炎伴颞颌关节损伤患者的口颌生理功能研究

目的 研究颞颌关节损伤对患有青少年类风湿性关节炎 (JCA)患儿的口颌功能的影响。方法 研究组选择 8例患有青少年类风湿性关节炎并且伴有颞下颌关节损伤的儿童 ,均为女性 ,分为两个阶段 ,第 1阶段平均12岁 ,第 2阶段平均 14岁。对照组选择 8例患有青少年类风湿性关节炎不伴有颞颌关节损伤的儿童 ,相同的性别、年龄。通过EMG ,颌运动状况及颞颌关节功能检查 ,分析口颌功能所受的影响。用t检验检查两组之间的差异 ,卡方检验检查对照两组两个阶段颌功能的不同。结果 研究组病人的口颌生理功能明显的低于对照组。

胸腔镜肺叶切除术:哥本哈根前路三切口手术经验

世界各地目前已广泛确立和开展电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）肺叶切除术。此前,该术式是否能够作为癌症治疗手术以及能否完成彻底的淋巴结清扫还存有争议。虽然目前仍缺乏适当的随机研究,但人们普遍认为胸腔镜手术治疗癌症的效果至少不亚于传统的开胸手术。有几篇论文的结论称两术式的存活率没有显著差异,而且VATS结果可能更好[1-3]。

Advances in endoscopic ultrasound imaging of colorectaldiseases

The development of endoscopic ultrasound(EUS) has had a significant impact for patients with digestive diseases, enabling enhanced diagnostic and therapeutic procedures, with most of the available evidence focusing on upper gastrointestinal(GI) and pancreaticobiliary diseases. For the lower GI tract the main application of EUS has been in staging rectal cancer, as a complementary technique to other cross-sectional imaging methods. EUS can provide highly accurate indepth assessments of tumour infiltration, performing best in the diagnosis of early rectal tumours. In the light of recent developments other EUS applications for colorectal diseases have been also envisaged and are currently under investigation, including beyond-rectum tumour staging by means of the newly developed forward-viewing radial array echoendoscope. Due to its high resolution, EUS might be also regarded as an ideal method for the evaluation of subepithelial lesions. Their differential diagnosis is possible by imaging the originating wall layer and the associated echostructure, and cytological and histological confirmation can be obtained through EUS-guided fine needle aspiration or trucut biopsy. However, reports on the use of EUS in colorectal subepithelial lesions are currently limited. EUS allows detailed examination of perirectal and perianal complications in Crohn's disease and, as a safe and less expensive investigation, can be used to monitor therapeutic response of fistulae, which seems to improve outcomes and reduce the need for additional surgery. Furthermore, EUS image enhancement techniques, such as the use of contrast agents or elastography, have recently been evaluated for colorectal indications as well. Possible applications of contrast enhancement include the assessment of tumour angiogenesis in colorectal cancer, the monitoring of disease activity in inflammatory bowel disease based on quantification of bowel wall vascularization, and differentiating between benign and malignant subepithelial tumours. Recent reports suggest that EUS elastography enables highly accurate discrimination of colorectal adenocarcinomas from adenomas, while inflammatory bowel disease phenotypes can be distinguished based on the strain ratio calculation. Among EUS-guided therapies, the drainage of abdominal and pelvic collections has been regarded as a safe and effective procedure to be used as an alternative for the transcutaneous route, while the placing of fiducial markers under EUS guidance for targeted radiotherapy in rectal cancer or the use of contrast microbubbles as drug-delivery vehicles represent experimental therapeutic applications that could greatly impact the forthcoming management of patients with colorectal diseases, pending on further investigations.

Semen analysis from an epidemiologic perspective

世界健康组织的第五个版本() 精液分析的手册第一次为人的精液特征包括参考价值。这篇论文考虑如此的价值是否将帮助解决在导致化学药品的版本进环境的人为的活动对男繁殖健康有害的精子计数和假设显示时间、地理的移动的强烈地辩论的数据。这些引用值不完成这些目的原因也被解释。尽管为精液特征的确定的引用值具有在分析流行病的研究的有限价值， WHO 指南具有为支持适当研究协议的开发的最大的重要性。而且尽管有它的限制，精液分析仍然是在流行病学的研究，和没有上级的一个有用研究工具，选择在地平线上。

Systematic review of the prevalence and development of osteoporosis or low bone mineral density and its risk factors in patients with inflammatory bowel disease

BACKGROUND The inflammatory bowel diseases(IBD),Crohn’s disease(CD)and ulcerative colitis(UC)are chronic,immune-mediated disorders of the digestive tract.IBD is considered to be a risk factor for developing osteoporosis;however current literature on this matter is inconsistent.AIM To assess prevalence and development of osteoporosis and low bone mineral density(BMD),and its risk factors,in IBD patients.METHODS Systematic review of population-based studies.Studies were identified by electronic(January 2018)and manual searches(May 2018).Databases searched included EMBASE and PubMed and abstracts from 2014-2018 presented at the United European Gastroenterology Week,the European Crohn’s and Colitis Organisation congress,and Digestive Disease Week were screened.Studies were eligible for inclusion if they investigated either the prevalence of osteoporosis or osteopenia and/or risk factors for osteoporosis or low BMD in IBD patients.Studies on children under the age of 18 were excluded.Only population-based studies were included.All risk factors for osteoporosis and low BMD investigated in any included article were considered.Study quality and the possibility of bias were analysed using the Newcastle-Ottawa scale.RESULTS Twelve studies including 3661 IBD patients and 12789 healthy controls were included.Prevalence of osteoporosis varied between 4%-9%in studies including both CD and UC patients;2%-9% in studies including UC patients, and 7%-15% instudies including CD patients. Among healthy controls, prevalence ofosteoporosis was 3% and 10% in two studies. CD diagnosis, lower body massindex (BMI), and lower body weight were risk factors associated withosteoporosis or low BMD. Findings regarding gender showed inconsistent results.CD patients had an increased risk for osteoporosis or low BMD over time, whileUC patients did not. Increased age was associated with decreased BMD, and therewas a positive association between weight and BMI and BMD over time. Greatheterogeneity was found in the included studies in terms of study methodologies,definitions and the assessment of osteoporosis, and only a small number ofpopulation-based studies was available.CONCLUSIONThis systematic review found a possible increase of prevalence of osteoporosis inCD cohorts when compared to UC and cohorts including both disease types.Lower weight and lower BMI were predictors of osteoporosis or low BMD in IBDpatients. The results varied considerably between studies.

Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction

从室的纤维性颤动(VF ) 的突然的心脏的死亡(SCD ) 在冠的动脉疾病(CAD ) 期间是全部、心血管的死亡的一个领先的原因，并且在里面多于 SCD 盒子的一半， VF 作为 CAD 的第一症状发生。几流行病学的研究证明了一个家庭成员的突然的死亡在尖锐心肌的梗塞(MI ) 期间是为 SCD 和 VF 的一个风险因素，独立于包括 MI 的家庭历史的传统的风险因素，在危险性建议一个基因部件到 VF。由于 MI 阻止 SCD 和 VF，我们需要在这张显然健康的人口引起 VF 的基因、分子的机制的更好的理解。尽管新卓见和技术变得可得到，到 VF 的基因倾向在 MI 期间仍然保持糟糕理解。，从许多不同基因研究的调查结果没能到达重制度几基因变体，普通、稀罕的变体，被联系了到 VF 或 SCD。为这评论，我们在 PubMed 找了潜在地相关的文章，用下列网孔术语：突然的心脏的死亡，室的纤维性颤动， out-of-hospital 心脏的拘捕，心肌的梗塞，心肌的局部缺血，冠的动脉疾病，和遗传。这评论由于 MI 为基因危险性描述传染病学和证据到 VF。

Can fecal microbiota transplantation cure irritable bowel syndrome?

AIM To verify the utility of treatment with fecal microbiota transplantation(FMT) in patients with irritable bowel syndrome(IBS).METHODS We searched EMBASE, Cochrane Library and Pub Med in March, 2017. The reviewed literature was based on two systematic searches in each of the databases. The Me SH terms used were IBS and fecal microbiota transplantation and the abbreviations IBS and FMT. Reference lists from the articles were reviewed to identify additional pertinent articles. RESULTS A total of six conference abstracts, one case report, one letter to the editor, and one clinical review were included. In the final analysis, treatment of 48 patients was evaluated. Treatment revealed an improvement in 58% of cases. The varying structure of the nine included studies must be taken into consideration.CONCLUSION Data on FMT and IBS are too limited to draw sufficientconclusions. Standardized double blinded randomized clinical trials need to be carried out to evaluate the effect of FMT on IBS.

Dolichocolon revisited: An inborn anatomic variant with redundancies causing constipation and volvulus

The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon found during autopsy. In 1912, Kienb?eck first visualized a redundant colon using bismuth, and Lardennois and Auborg named the anatomic variant dolichocolon in 1914. The criteria were later: A sigmoid loop rising over the line between the iliac crests, a transverse colon below the same line and extra loops at the flexures. The incidence of dolichocolon is 1.9%-28.5%. Dolichocolon seems to be congenital, as fetuses, newborns, and infants exhibit colonic redundancies. Studies have identified a triade of constipation, abdominal pain, and distension. Colon transit time was recently shown to increase significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis of dolichocolon is established by barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.

Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects

In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. This affects both the haemodynamic and functional homeostasis of many organs and largely determines the course of the disease. With the progression of the disease, the circulation becomes hyperdynamic with cardiac, pulmonary as well as renal consequences for dysfunction and reduced survival. Infections and a changed cardiac function known as cirrhotic cardiomyopathy may be involved in further aggravation of other complications such as renal failure precipitatingthe hepatorenal syndrome.Patients with end-stage liver disease and related complications as for example the hepatopulmonary syndrome can only radically be treated by liver transplantation.As a bridge to this treatment,knowledge on the mechanisms of the pathophysiology of complications is essential for the choice of vasoactive drugs,antibiotics,drugs with specific effects on fibrogenesis and inflammation,and drugs that target specific receptors.

Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: A randomized controlled study

AIM: To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the Prometheus? liver assist system in a randomized, controlled study. METHODS: Twenty-four patients were randomized to either the study group or to one of two control groups: Fractionated Plasma Separation Adsorption and Dialysis, Prometheus? system (Study group; n = 8); Molecular Adsorbent Recirculation System (MARS)? (Control group 1, n = 8); or hemodialysis (Control group 2; n = 8). All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS: Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group (P = 0.008). No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group (P = 0.03) and hemodialysis group (P = 0.04). Platelet count deceased in the Prometheus group (P = 0.04).CONCLUSION: Extra-corporal liver support with Prometheus is proven to be safe in patients with end- stage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group.

Molecular confocal laser endomicroscopy:A novel technique for in vivo cellular characterization of gastrointestinal lesions

While flexible endoscopy is essential for macroscopic evaluation,confocal laser endomicroscopy(CLE)has recently emerged as an endoscopic method enabling visualization at a cellular level.Two systems are currently available,one based on miniprobes that can be inserted via a conventional endoscope or via a needle guided by endoscopic ultrasound.The second system has a confocal microscope integrated into the distal part of an endoscope.By adding molecular probes like fluorescein conjugated antibodies or fluorescent peptides to this procedure(either topically or systemically administered during on-going endoscopy),a novel world of molecular evaluation opens up.The method of molecular CLE could potentially be used for estimating the expression of important receptors in carcinomas,subsequently resulting in immediate individualization of treatment regimens,but also for improving the diagnostic accuracy of endoscopic procedures by identifying otherwise invisible mucosal lesions.Furthermore,studies have shown that fluorescein labelled drugs can be used to estimate the affinity of the drug to a target organ,which probably can be correlated to the efficacy of the drug.However,several of the studies in this research field have been conducted in animal facilities or in vitro,while only a limited number of trials have actually been carried out in vivo.Therefore,safety issues still needs further evaluations.This review will present an overview of the implications and pitfalls,as well as future challenges of molecular CLE in gastrointestinal diseases.

Feasibility of progressive strength training shortly after hip fracture surgery

AIM: To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients.METHODS: This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured kneeextension and bilateral leg press strength training(twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum(RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme.RESULTS: Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk(P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise(P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g., the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m(P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance. CONCLUSION: Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb.

Does ethnicity and education influence preoperative disability and expectations in patients undergoing total knee arthroplasty?

AIM To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.METHODS We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty(TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born inthe study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.RESULTS We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative(preOP) oxford knee score(OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS(18.6 vs 23.9, P < 0.001), higher pain levels(VAS 73.0 vs 58.7, P < 0.001), expected higher levels of post-OP pain(VAS 14.1 vs 6.1, P = 0.02) and of overall symptoms(VAS 16.6 vs 6.4, P = 0.006). Patients with > 12 years education had lower mean pre-OP OKS(21.5 vs 23.8 and 24.6, P < 0.001) and higher pre-OP VAS pain(65.4 vs 59.2 and 56.4, P < 0.001) compared to groups with shorter education. One year post-operative(post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low(44.6%), and therefore post-OP results were not considered to be significant.CONCLUSION Minority ethnicity and the duration of education influ-ence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.

Persistent organic pollutants and male reproductive health

Environmental contaminants such as persistent organic pollutants （POPs） are man-made bioaccumulative compounds with long half-lives that are found throughout the world as a result of heavy use in a variety of consumer products during the twentieth century. Wildlife and animal studies have long suggested adverse effects of exposure to these compounds on human reproductive health, which, according to the endocrine disrupter hypothesis, are ascribed to the compounds＇ potential to interfere with endocrine signaling, especially when exposure occurs during certain phases of fetal and childhood development. An extensive number of epidemiological studies have addressed the possible effects of exposure to POPs on male reproductive health, but the results are conflicting. Thus far, most studies have focused on investigating exposure and the different reproductive health outcomes during adulthood. Some studies have addressed the potential harmful effects of fetal exposure with respect to malformations at birth and/ or reproductive development, whereas only a few studies have been able to evaluate whether intrauterine exposure to POPs has long-term consequences for male reproductive health with measurable effects on semen quality markers and reproductive hormone levels in adulthood. Humans are not exposed to a single compound at a time, but rather, to a variety of different substances with potential divergent hormonal effects. Hence, how to best analyze epidemiological data on combined exposures remains a significant challenge. This review on POPs will focus on current knowledge regarding the potential effects of exposure to POPs during fetal and childhood life and during adulthood on male reproductive health, including a critical revision of the endocrine disruption hypothesis, a comment on pubertal development as part of reproductive development and a comment on how to account for combined exposures in epidemiological research.