5 research outputs found
The incidence and pattern of fractures in children under two years of age
No full textAbstract
The literature on fracture incidence and patterns in children under two years of age is sparse; thus, we set out to examine this. In addition, we estimated the occurrence of suspected inflicted injury, and its association with radiological “red flags”.
Material and methods: Retrospective, population based cross-sectional study, including all children under two years of age who presented at the A&E department at the University hospital in Tromsø due to a trauma warranting radiographic examination between January 1st, 2010, and December 31st, 2023. Patients were identified through searches in the PACS system. In addition to demographic data, we registered the number of days between the trauma, and the first radiographic examination, and mechanism of injury, as provided by the caretaker(s) / birth injury, whether an additional skeletal survey was performed, and if so, if there were any findings. All the radiographs were reviewed by the researchers. In accordance with established practice, an ethics committee review was not required (Regional Ethics committee (REK-N), number 2012/172). Data handling and storage were performed in accordance with the relevant guidelines and regulations and approved by the local data protection officer (PVO; 2024/4625-2).
Results: A total of 430 children (49.8% female) under the age of two, mean age 14.7 months (SD 6.8), were included, of whom 4 children sustained a high-energy trauma and 42 sustained a birth related trauma. No significant differences in the number of injuries (p=0.76) or fractures (p=0.84) were observed according to gender.
Of the 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with a non-birth related injury, 163 (42.0%) had a fracture, yielding an annual incidence of 4.3 per 1,000 children under the age of two. Infants had a significantly lower annual incidence as compared to children between 12 and 24 months of age (2.4 per 1,000 vs. 6.1 per 1,000, p = 0.01).
Fracture mechanisms for the 388 non-birth related injuries were, in declining order, 93 (23.9%) fall from more than own height/furniture; 67 (17.2%) fall from own height, 61 (15.7%) crush injury and 41 (10.6%) stretch/pull trauma. Notably, 53 (13.6%) injuries had an unknown mechanism. In 8 (2%) of the cases, no information on mechanism was available in the clinical journal.
47 of the 163 fractures (28.7%) involved the forearm while 40 (24.5%) were fractures to the leg. The number of fractures increased significantly by age group, with 6 (3.7%) fractures seen amongst 0-6-months-olds, 30 (18.4%) in those aged 6-12 months, 60 (36.8%) in the 12-18-months-olds and 64 (39.3%) in the 18-24-months-olds (p=0.039). No classic metaphyseal lesions were seen. The distribution of fractures differed according to age group, with skull fractures predominating in 0-6-months-olds (33.0%), clavicle fractures (33.0%) in 6-12-months-olds and forearm fractures in the two oldest age groups (35.0% and 34.4%, respectively) (p < 0.001). Four children sustaining a fracture, all of whom had radiological “red flags”, were subsequently diagnosed with inflicted injury by the Child Protection Services.
42 children sustained a birth-related injury, of whom 21 (50.0%) had a fracture, yielding a fracture-incidence of 1.1 per 1,000 live births. Fractures to the clavicle and humerus were the two most common locations.
Conclusion: Injuries and fractures in children under two years of age are rare, particularly in infants. The occurrence of classic metaphyseal injuries, or radiological “red flags” should raise suspicion of non-accidental injury and instigate further assessment.Abstract
The literature on fracture incidence and patterns in children under two years of age is sparse; thus, we set out to examine this. In addition, we estimated the occurrence of suspected inflicted injury, and its association with radiological “red flags”.
Material and methods: Retrospective, population based cross-sectional study, including all children under two years of age who presented at the A&E department at the University hospital in Tromsø due to a trauma warranting radiographic examination between January 1st, 2010, and December 31st, 2023. Patients were identified through searches in the PACS system. In addition to demographic data, we registered the number of days between the trauma, and the first radiographic examination, and mechanism of injury, as provided by the caretaker(s) / birth injury, whether an additional skeletal survey was performed, and if so, if there were any findings. All the radiographs were reviewed by the researchers. In accordance with established practice, an ethics committee review was not required (Regional Ethics committee (REK-N), number 2012/172). Data handling and storage were performed in accordance with the relevant guidelines and regulations and approved by the local data protection officer (PVO; 2024/4625-2).
Results: A total of 430 children (49.8% female) under the age of two, mean age 14.7 months (SD 6.8), were included, of whom 4 children sustained a high-energy trauma and 42 sustained a birth related trauma. No significant differences in the number of injuries (p=0.76) or fractures (p=0.84) were observed according to gender.
Of the 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with a non-birth related injury, 163 (42.0%) had a fracture, yielding an annual incidence of 4.3 per 1,000 children under the age of two. Infants had a significantly lower annual incidence as compared to children between 12 and 24 months of age (2.4 per 1,000 vs. 6.1 per 1,000, p = 0.01).
Fracture mechanisms for the 388 non-birth related injuries were, in declining order, 93 (23.9%) fall from more than own height/furniture; 67 (17.2%) fall from own height, 61 (15.7%) crush injury and 41 (10.6%) stretch/pull trauma. Notably, 53 (13.6%) injuries had an unknown mechanism. In 8 (2%) of the cases, no information on mechanism was available in the clinical journal.
47 of the 163 fractures (28.7%) involved the forearm while 40 (24.5%) were fractures to the leg. The number of fractures increased significantly by age group, with 6 (3.7%) fractures seen amongst 0-6-months-olds, 30 (18.4%) in those aged 6-12 months, 60 (36.8%) in the 12-18-months-olds and 64 (39.3%) in the 18-24-months-olds (p=0.039). No classic metaphyseal lesions were seen. The distribution of fractures differed according to age group, with skull fractures predominating in 0-6-months-olds (33.0%), clavicle fractures (33.0%) in 6-12-months-olds and forearm fractures in the two oldest age groups (35.0% and 34.4%, respectively) (p < 0.001). Four children sustaining a fracture, all of whom had radiological “red flags”, were subsequently diagnosed with inflicted injury by the Child Protection Services.
42 children sustained a birth-related injury, of whom 21 (50.0%) had a fracture, yielding a fracture-incidence of 1.1 per 1,000 live births. Fractures to the clavicle and humerus were the two most common locations.
Conclusion: Injuries and fractures in children under two years of age are rare, particularly in infants. The occurrence of classic metaphyseal injuries, or radiological “red flags” should raise suspicion of non-accidental injury and instigate further assessment
Comparable long-term outcomes in patients undergoing total disc replacement or anterior cervical discectomy and noninstrumented fusion
No full textBACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past 2 decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of develop-ing ASD. However, since the method was first introduced in the early 2000s, the long-term out-come after it is still not completely understood.PURPOSE: Our goal was to compare the long-term outcomes of TDR and ACDF procedures. STUDY DESIGN: Retrospective case-control study.PATIENT SAMPLE: All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease.OUTCOME MEASURES: The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological out-comes, and employment status. METHODS: The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least 2 years after index surgery.RESULTS: The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p=.096, ns.). Total disc replacement patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs 1.3%, p=.026). None of the TDR patients underwent further cervical surgery more than 6 years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically nonsignificant. TDR was signifi-cantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group. CONCLUSIONS: There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically nonsignificant.How-ever, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them.(c) 2023 Elsevier Inc. All rights reserved.Peer reviewe
UCHL5 expression associates with improved survival in lymph-node-positive rectal cancer
No full textColorectal cancer is among the three most common cancer types for both genders, with a rising global incidence. To date, prognostic evaluation is difficult and largely dependent on early detection and successful surgery. UCHL5/Uch37 is an integral part of the protein homeostasis network as one of the three deubiquitinating enzymes associated with the 26S proteasome. Here, we have investigated in colorectal cancer the possible association of UCHL5 tumor expression and patient survival. UCHL5 tumor expression was evaluated by immunohistochemistry in 779 surgically treated colorectal cancer patients from Helsinki University Hospital, Finland, with assessment of clinicopathological parameters and the effect of UCHL5 expression on patient survival. High and undetectable UCHL5 expression both correlated with increased overall disease-specific survival in the subgroup of patients with lymph-node-positive (Dukes C/stage III) rectal cancer. Within this subgroup of 105 stage-III rectal cancer patients, none of the 7 with high UCHL5 expression died of colorectal cancer within 10 years after surgery (p = 0.012). A similar, though less prominent, survival trend occurred throughout the whole patient cohort. In conclusion, UCHL5 is a promising novel prognostic marker in lymph-node-positive rectal cancer. Our results also advance the currently limited knowledge of biomarkers in colorectal cancer treatment.Peer reviewe
Author Correction:Uncovering a population of gravitational lens galaxies with magnified standard candle SN Zwicky
No full textCorrection to: Nature Astronomy https://doi.org/10.1038/s41550-023-01981-3. Published online 12 June 2023.In the version of this article initially published, the given name of Jozsef Vinko was misspelled as Yozsef and has now been corrected in the HTML and PDF versions of the article.<p/
Immunodeficiency syndromes differentially impact the functional profile of SARS-CoV-2-specific T cells elicited by mRNA vaccination
No full textMany immunocompromised patients mount suboptimal humoral immunity after SARS-CoV-2 mRNA vaccination. Here, we assessed the single-cell profile of SARS-CoV-2-specific T cells post-mRNA vaccination in healthy individuals and patients with various forms of immunodeficiencies. Impaired vaccine-induced cell-mediated immunity was observed in many immunocompromised patients, particularly in solid-organ transplant and chronic lymphocytic leukemia patients. Notably, individuals with an inherited lack of mature B cells, i.e., X-linked agammaglobulinemia (XLA) displayed highly functional spike-specific T cell responses. Single-cell RNA-sequencing further revealed that mRNA vaccination induced a broad functional spectrum of spike-specific CD4(+) and CD8(+) T cells in healthy individuals and patients with XLA. These responses were founded on polyclonal repertoires of CD4(+) T cells and robust expansions of oligoclonal effector-memory CD45RA(+) CD8(+) T cells with stem-like characteristics. Collectively, our data provide the functional continuum of SARS-CoV-2-specific T cell responses post-mRNA vaccination, highlighting that cell-mediated immunity is of variable functional quality across immunodeficiency syndromes
