Introduction: Une procédure fréquente pour la prévention de l’arthrose de la cheville est une ostéotomie corrective du tibia distal (SMOT). Le Distal Tibia Nail (DTN ; Mizuho®), a été développé pour la réduction des fractures du tibia distal. L’objectif de ce projet était d’analyser la faisabilité du DTN pour des procédures SMOT effectuées avec une ouverture médiale (MWO). Méthodes : Au total 16 Sawbones® ont été instrumentés par un DTN ou une plaque (MDTP, Synthes®), suivi par la simulation d’une MWO. Quatre phases d’expérimentation étaient définies : Phase-0, Sawbones sans implant ni MWO ; Phase-1, échantillons avec un implant et MWO. Phase-2, les échantillons de la Phase-1 avec le cortex latéral fracturé ; Phase-3, simulation d’une fracture de type A3. La raideur et le mouvement inter-fragmentaire (IFM) étaient analysés. Des tomographies des échantillons ont été prises à Phases 0 et 1. Résultats : Jusqu’à 80% de différence était présente enter les Sawbones® de Phase-0 ; dans les Phases 1 et 2, des différences importantes se sont montrées entre des implants mais équivalent à <2 mm d’IFM. Le DTN a démontré une résistance très élevée aux charges appliquées en comparaison avec le MDTP pour la fixation des fractures A3. Des facteurs expérimentaux tels que la raideur initiale des Sawbones®, l’axe de chargement, et le positionnement de l’échantillon dans la machine d’essai, peuvent tous avoir une influence importante sur la raideur mesurée. Conclusion : Le DTN peut être considéré comme option pour la fixation des SMOT effectués avec un MWO. Des études futures doivent faire attention aux conditions limites ayant un effet sur des critères d’évaluation et des conclusions tirées / Introduction: Supra-malleolar corrective osteotomies (SMOT) are a common surgical procedure for the prevention of early onset of ankle arthritis. The Distal Tibia Nail (DTN; Mizuho®), was previously developed for the reduction of distal tibia fractures. The aim of this project was to identify error sources in biomechanical testing, and to test the feasibility of the DTN for SMOT performed using the medial wedge opening (MWO) technique. Methods: A total of 16 Sawbones® were each implanted with either a DTN or medial distal tibia plate (MDTP; Synthes®), and a MWO simulated. Four testing phases were defined: Phase-0, testing of Sawbones® without implant/osteotomy; Phase-1, samples with MWO and implant; Phase-2, Phase-1 samples with lateral cortex fractured; Phase-3, samples with an A3 type fracture. Stiffness construct and interfragmentary movement (IFM) were analysed. CT scans were taken of the samples at Phases 0 and 1. Results: Up to 80% difference was noticed between Sawbones® samples in Phase-0; in Phases 1 and 2 significant differences were found between stiffness constructs of the implant groups but this amounted to <2 mm IFM. The DTN was significantly more resistant to compression and torsion when supporting an A3 fractures (Phase-3). Elements such as original Sawbones® stiffness construct, implant position, potting material, loading axis, and sample positioning can have a high influence on measured stiffness and bias the results. Conclusion: The DTN is a viable option for the fixation of SMOT performed with a MWO technique. Future studies should pay careful attention to boundary conditions affecting outcomes measures and drawn conclusions

Bakgrund: I Sverige är den generella uppfattningen att det vid val av vardagssko är rekommenderat att välja en sportsko framför en canvas tennissko. Tidigare studier har jämfört hur olika skomodeller påverkar gången, men ingen har studerat skillnader mellan sportskor och canvas tennisskor. Syfte: Undersöka hur en sko med instabil läst och platt bindsula (canvas tennissko) samt en sko med en stadig läst, en sula med bra stötdämpning och avrullning (sportsko) påverkar den mediolaterala stabiliteten olika under stödfasen. Metod: Gånganalys på fem kvinnliga deltagare. Kinetisk och kinematisk data samlades in med hjälp av ett 3D-rörelseanalyssystem. Resultat: Rörelseomfånget skiljer sig mer mellan deltagare än skomodeller. Sportskor har ett försumbart lägre rörelseomfång än canvas tennisskor. Sportskor ger mer inverterad gång än Canvas tenniskor. Steglängden och stödfasen (stance time) skiljer inte mellan de två skomodellerna. Slutsats: Fotens rörelseomfång i frontalplanet skiljer sig inte mellan canvas tennisskor och sportskor under stödfasen, men sportskon har en mer inverterad rörelse. / Background: In Sweden it is a general perception that a sports shoe is a better choice than a canvas tennis shoe for everyday use. Previous studies have investigated how different shoe models affect the gait, but none have studied the differences between sport shoes and canvas tennis shoes. Aim: Investigate how a shoe with unstable last and a flat insole (canvas tennis shoe) and a shoe with steady last, a sole with good shock absorbing and roll off (sport shoe) affect the mediolateral stability differently during stance. Methods: Gait analysis on five female participants. Kinetic and kinematic data collected with3D-modionanalysis system. Results: The range of motion differs more between participants than between shoe models. The sport shoe have a negligible lower range of motion than the canvas tennis shoe. Walking in sport shoe shows a more inverted gait than gait in canvas tennis shoe. Step length and stance time are the same in both shoe models. Conclusion: The range of motion and motion pattern of the foot in the coronal plane does not differ between canvas tennis shoes and sport shoes during stance phase, but the sport shoe has a more inverted motion.

Doctor Educationis / This study was a cephalometric and dental investigation of the treatment outcomes of UCLP children treated at the Red Cross Children's Hospital (RCCH) with respect to craniofacial morphology and dental arch relationship. The quality of the outcome for the RCCH group was compared with the outcomes reported for the Six-Centre International Study (Melsted et al., 1992; Mars et al., 1992). The sample consisted of 20 (11 females, 9 males) consecutively treated UCLP children who had cephalometric and dental records taken between the ages of8 to 11years (mean 10.13 ± 1.2 years). The cephalometric analysis described by Melsted et al. (1992) was used to evaluate the skeletal and soft tissue morphology. The quality of the dental arch relationship was measured according to the Gosion Yardstick (Mars et al., 1987). The treatment outcome of children treated at the RCCH was evaluated with respect to craniofacial form and dental arch relationship. When comparing the mean cephalometric skeletal parameters of the RCCH to the six centres in the Eurocleft study, a significant difference was found between the RCCH group and centre D for most of the variables. A significant increase in the upper incisor inclination and maxillary inclination was found in the RCCH patients compared to the European centres. The difference in the soft tissue parameters was limited to the relative protrusion of the nose and the sagittal soft tissue variable sss-ns-pgs. The analysis of the Goslon scores showed a significant difference between the RCCH group and centres C, D, and F. According to the Goslon score, 85% of the RCCH patients had good to satisfactory dental arch relationship, which was comparable to that recorded for centres A(92%), B(89%) and C(94). In conclusion, the results of the cephalometric analysis and the Goslon Yardstick showed a significant difference between the RCCH group and centre D. The GosIon score indicated good quality of the dental arch relationship, which faired favourably with the better centres in the Six Centre Study.

Höftfrakturer hos äldre kommer att bli ett stort globalt hälsoproblem på grund av den snabbt växande åldrande befolkningen. En höftfraktur kan medföra en rad negativa konsekvenser i det dagliga livet, därmed är det viktigt att belysa hur de äldre upplever livet efter höftfrakturen. Syftet med denna studie var att belysa de äldres upplevelse av dagligt liv efter höftfraktur. Studien är en litteraturöversikt med induktiv ansats genom manifest innehållsanalys och består av tio vetenskapliga artiklar med både kvalitativa och kvantitativa ansatser. Resultatet presenteras i tre huvudkategorier: upplevda förändringar i dagligt liv, upplevelser av behov av rehabilitering, upplevelser av behov av socialt stöd. De äldre upplever förändringar i det dagliga livet efter höftfrakturen från ett fysiskt och psykiskt samt socialt perspektiv. De behöver olika former av stöd för att kunna återvända till sin fungerande vardag. Vidare forskning bör lägga fokus på könsspecifik kunskap om förändringar i det dagliga livet hos de äldre med höftfrakturer. / Hip fractures in the elderly will be a major global health problem due to the rapidly growing elderly population. A hip fracture can result in several negative consequences in daily life, thus it is important to highlight how the elderly experience life after the hip fracture. The aim of this study was to illuminate the elderly’s experience of daily life after hip fracture. The study is a literature review with inductive approach through manifest content analysis and consists of ten scientific articles with both qualitative and quantitative approaches. The result is presented in three main categories: experienced changes in daily life, experiences of need of rehabilitation, experiences of need of social support. The elderly experience changes in the daily life after the hip fracture from a physical and mental as well as social perspective. They need different forms of support to be able to return to their functional daily life. Further research should focus on gender-specific knowledge regarding changes in the daily life of the elderly with hip fractures.

För att förebygga komplikationer vid kirurgiska ingrepp är den preoperativa fasen viktig. Sjuksköterskans roll innebär bland annat att försöka skapa trygghet samt ge adekvat information till patienten. Syftet med studien var att undersöka följsamheten gällande preoperativa riktlinjer och allmänna omvårdnadsåtgärder. Vid datainsamlingen utfördes totalt nio observationer på sju sjuksköterskor i deras arbetsmiljö. Studien utgör en kvalitets¬säkring och sammanställdes med stöd av innehållsanalys. Resultatet visade att tiden var en påverkande faktor, mer tid och resurser hade kunnat öka följsamheten ytterligare. Trots det speglar resultatet en god följsamhet gällande de praktiska preoperativa riktlinjerna, men det saknades fullgod kommunikation för att se till patientens inre behov. Slutsatserna visar på att det behövs fortlöpande utbildning gällande patientundervisning. Det är av stor vikt att lyssna på patienten, inte endast vad hon eller han säger, utan vad hon eller han egentligen förmedlar, med bland annat sitt kroppsspråk. / The preoperative phase is important to prevent complications during surgical procedures. The nursing role is to create safety and to give adequate information to the patient. The aim of the study was to examine the compliance regarding the preoperative guidelines and general caregiving procedures. During the data collection, nine observations were made on seven nurses in their working environment. The study can be applied as a quality assurance and was analysed by content analysis. The result shows that time was an influencing factor, and more time and resources would make it easier to increase the compliance. The result also shows that the compliance was good regarding practical preoperative guidelines. However complete communication skills were missing, to see the inner needs of the patient. The conclusion shows that there is a continuing need to develop the nurses skill regarding patient education. It is important to listen to the patient, not only to what is being said, but to what he or she really means, including body language.

Background: The number of people with diabetes is rising globally, and they are at higher risk of foot complications that can ultimately result in lower limb amputation. Additionally, individuals with diabetes whoundergo amputation are more likely to lose the contralateral limb. Consistent care and preventive measuresare crucial for reducing the risk of further amputations. Aim: This study aims to explore the current experience of certified prosthetist and orthotist in Denmarkconcerning the assessment of the contralateral limb in individuals with diabetes who utilize a lower limbprosthesis. Method: A qualitative study with an exploratory research design was conducted. Thematic analysis, using aninductive approach was employed to analyze data from eight semi-structured interviews with CPOs from Denmark. Findings: The analysis of the interview results revealed three main themes - responsibility, prioritization,and barriers - which frequently overlap. Each theme had multiple sub-themes which highlights the variationin the participants’ experiences. Conclusion: The variation in responses gathered from the interviews unveiled diverse perspectives on responsibility, prioritization, and barriers which points to a lack of clear guidelines in the Danish healthcaresystem regarding this assessment of the contralateral limb in this patient group. This study offers novel insightsinto the diverse experiences and decision-making processes of Danish CPOs when it comes to the contralaterallimb assessment in diabetic foot care. / <p></p><p></p>

Syftet med denna litteraturöversikt var att beskriva knäfunktionen och idrottsdeltagandet hos bollsportsutövare på elitnivå som drabbats av korsbandsskada, med fokus på skillnader mellan de som genomgått operation och de som valt konservativ behandling. För att besvara syftet användes tre frågeställningar. En syftade till att svara på om det fanns skillnader i knäfunktionen hos de som blir opererade och de som genomgått konservativ behandling. De två andra frågeställningarna fokuserade på om bollsportsutövarna kom tillbaka på samma nivå som innan skadan, gällande båda behandlingsmetoderna. Den systematiska artikelsökningen utfördes i två databaser, MEDline och PubMed, där utfallet blev 11 inkluderade artiklar. Några av inklusionskriterierna var att artiklarna skulle innehålla bollsportsutövare på elitnivå som haft en korsbandsskada och genomgått antingen operation eller konservativ behandling. Innehållet analyserades genom granskningsmallar och riktlinjer för kvalitetsgranskning. Resultatet visade att knäfunktionen skiljde sig mellan opererade och konservativt behandlade bollsportsutövare på elitnivå. I uppföljningsstudier 1-2 år efter behandling visade denna litteraturöversikts resultat att de konservativt behandlade har bättre knäfunktion än de opererade. Vid längre uppföljningar (&gt;2 år) visade däremot resultaten på att de opererade elitidrottarna har bättre knästabilitet än de konservativt behandlade. Gällande återgång till idrott kom bollsportsutövarna på elitnivå tillbaka till samma nivå som innan skadan både efter operation och konservativ behandling. Slutsatsen blev att det inte fanns någon betydande skillnad mellan opererade och konservativt behandlade elitidrottare gällande återgång till idrott och knäfunktion. Med kunskapen som denna litteraturöversikt har bidragit med, bör det finnas större förtroende för konservativ behandling.

Covalent modifications of histone tails play essential roles in mediating chromatin structure and epigenetic regulation. JmjD3 is a JumonjiC domain containing histone demethylase, belongs to the KDM6 subfamily, and catalyses the removal of methyl groups on methylated lysine 27 on histone 3 (H3K27), a critical mark to promote polycomb mediated repression and gene silencing. The importance of JmjD3 has been implicated in development, cancer biology and immunology. In this thesis, I report the recombinant production of active human JmjD3, development of two in vitro screening assays, a cell-based assay, and structural determination of JmjD3 in complex with the inhibitor 8-hydroxy-5-carboxyquinoline (8HQ). A highly selective and potent small molecule inhibitor GSK-J1 was subsequently identified. The inhibitor is active in HeLa cells and promotes a dose-dependent increase of global H3K27 methylation. The inhibitor GSK-J1 was used in two different cell assay systems related to inflammation and differentiation, to understand how H3K27 demethylation controls cellular functions. By inhibiting H3K27me3 demethylation, it is demonstrated that tumor necrosis factor (TNF) and other pro-inflammatory cytokines are regulated by H3K27 demethylase inhibition in M1- type macrophages derived from healthy volunteers and rheumatoid arthritis patients. It is also shown that inhibition of H3K27me3 demethylation abrogates cellular fusion of M2- type macrophages. During RANKL induced osteoclast differentiation, JmjD3 is up-regulated and promotes the expression of the key transcription factor NFATc1. By inhibiting JmjD3, NFATc1 expression is reduced and osteoclastogenesis is inhibited. This mechanism demonstrates a novel anti-resorptive principle of potential utility in conditions of excess bone resorption such as osteoporosis, bone erosion in inflammatory arthritis or cancer of the bone. These experiments further resolve the ambiguity between scaffold and catalytic function associ- ated with the H3K27 demethylase in these biological systems, and demonstrate that its enzymatic activity is crucial for epigenetic regulation of macrophage and osteoclast function.

The purpose of this study on hand injury from powered wood splitters was to describe injury epidemiology and anatomy, to rate injury severity, to evaluate the outcome after injury and to describe factors of possible importance for the occurrence of injury. By searching a computerized patient registry, 131 patients injured by wood splitters from 1995 to 2001 were identified. Information was obtained from hospital records and radiographs, a written questionnaire and a structured telephone interview. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (DASH) and, in 26 of the most severely injured patients, with the Sollerman test. Forty-six percent of the injuries occurred during April or May. Wedge splitters caused 82 % of all injuries and most often injured the index finger, while screw splitters caused 18 % of all injuries and most often injured the metacarpus. Screw splitters caused palmar perforation and thumb avulsion. Sixty-three percent of all patients had an amputation or devascularising injury. The reliability of HISS rating was good. The mean Hand Injury Severity Score (HISS) was 63 which is equivalent to a severe hand injury. The mean ISS was 3.7. Nineteen percent of patients had minor, 31 % had moderate, 23 % had severe and 27 % had major injury according to the HISS system. Children had more severe injuries than adults. There was no significant difference regarding HISS or DASH scores between wedge and screw splitter injuries. The mean DASH score was 15, indicating moderate residual sequelae, but patients without sequelae and patients with grave sequelae were found in all HISS severity grades. There was a weak but significant correlation between the HISS and DASH scores. The mean Sollerman score in the injured hand was 66, indicating significantly impaired hand function. Twenty-nine percent of splitters were home-made. Very few machines had the safety measures required by European Standards. Children were present during splitting in at least 15 % of cases. Not being alone at the machine was one cause of wedge splitter injury. Glove use was one cause of screw splitter injury. Hand injury from powered wood splitters is a significant problem. Many of the injuries are severe, and cause long term sequels and impairment of hand function. Prevention is essential and should focus on unsafe machines and dangerous patterns of use.

The aim of the thesis was to explore the stakeholders’ opinions on and experiences with donation of used assistive devices from high-income countries to developing countries. Which was done by investigating the opinions and experiences of the different stakeholders, with donation of used assistive devices, and by exploring what used assistive devices are appropriate to donate.   The study included eight participating stakeholders, requited through purposive and snowball sampling. Of the eight participants, five participants were sending stakeholders from Scandinavia and three participants were receiving stakeholders from lower-middle-income countries in Africa and an upper-middle-income country in Europe. The interviews were conducted using semi-structured questions to explore the participants’ own opinions and experiences with donations. Qualitative content analysis was used to analyze the transcribed interviews inductively and with manifest content.  The results consisted of 4 main categories: Practical issues, Stakeholders opinions and cooperation, Donations are needed, and Considerations when donating. The main findings of the study were; the importance of quality control to ensure waste is not sent, the importance of communication between sender and receiver about needs, the importance of knowledge of the prerequisites and context of the receiver, and lastly, the importance of considering the responsibility of waste when the donations are worn out. In conclusion, the included stakeholders have a positive attitude towards donations and expressed a need for more knowledge. / Målet med dette studie var at undersøge interessenternes holdninger til og oplevelser med donation af brugte hjælpemidler fra lande med høj indkomst til udviklingslande. Dette vil blive gjort ved at undersøge holdningerne og oplevelserne fra de forskellige interessenter, om donation af brugte hjælpemidler, og ved at udforske hvilke brugte hjælpemidler der er passende at donere.  Studiet inkluderede otte deltagende interessenter, som blev rekrutteret gennem formålsrettet og snowball sampling. Ud af de otte deltagere var fem deltagere afsender interessenter fra Skandinavien og tre deltagere var modtager interessenter fra lande med middellav indkomst i Afrika og et land i Europa med middelhøj indkomst. Interviewerne var udført ved at bruge semistrukturerede spørgsmål for at udforske deltagernes egne meninger og oplevelser omkring donation. Kvalitativ indholdsanalyse var brugt til at analysere de transskriberede interviews induktivt og med manifest indholdsforståelse. Resultaterne beståede af fire hovedkategorier: Praktiske problemer, Interessenters meninger og samarbejde, Der er behov for donationer og Overvejelser ved at donere. Hovedresultaterne af studies var; vigtigheden af kvalitetskontrol for at sikre at der ikke bliver sendt skrald, vigtigheden af kommunikation mellem afsender og modtager angående behov, vigtigheden af viden omkring modtagerens forudsætninger og kontekst, og sidst, vigtigheden af at overveje ansvaret for affald, når donationerne er udtjente. Som konklusion har de inkluderede interessenter haft en positiv attitude omkring donation og udtrykt et behov for mere viden.