Modern emergency care is aimed at a safe and quick discharge of the patient.

In Finland, there has been a need to develop emergency care in the past years because of the government's statutes and the need to meet the international standards. Emergency medicine as a newcomer specialty has encouraged the process. Emergency physicians are expected to take more responsibility of patient flow and treatment in the emergency departments (ED). The observation unit is an important part of the ED. It allows patients to be treated on a short-term basis, and patient care is efficient due to the close communication between specialties. Patient selection is in the essence of a well-functioning observation ward.

Gender difference in genetic association between IL1A variant and early lumbar disc degeneration: a three-year follow-up.

OBJECTIVE: The purpose of the present study was to analyze the associations between specific genetic markers and early disc degeneration (DD) or early disc degeneration progression (DDP) defined by magnetic resonance imaging (MRI). METHODS: We selected eleven of the most promising single nucleotide polymorphisms (SNP) and compared the distributions of these genetic markers between groups defined by MRI in a Danish adolescent population (N=166) over a three-year follow-up period. RESULTS: We observed a ten-fold higher annual incidence of endplate changes than previously reported in adults. The gender difference in IL1A rs1800587 association with DD remained significant and another association with DDP emerged in follow-up assessment. Among girls, the rs1800587 T-allele was associated both with DD (OR 2.82 [95% CI 1.29-6.16]) and with DDP (OR 2.45 [95% CI 1.03-5.82]). Among boys, the IL6 rs1800795 genotype G/C was protective in both DD (OR 0.26 [95% CI 0.09-0.72]) and DDP (OR 0.32 [95% CI 0.12-0.88]) with the IL6 rs1800797 genotype G/A was associated with a decreased likelihood of DD (OR 0.27 [95% CI 0.10-0.77]). Gender-genotype interactions were significant for polymorphisms in both IL1A and IL6. Correction for multiple testing weakened the associations for IL6 polymorphisms. CONCLUSION: We conclude that gender specific effects in lumbar disc degeneration and its progression are possible. However, further evaluations in larger populations are needed. Our results provide some support to the hypothesis that early disc degeneration is an especially important phase in the cascade of degenerative disc disease.

Genetic susceptibility of intervertebral disc degeneration among young Finnish adults.

BACKGROUND: Disc degeneration (DD) is a common condition that progresses with aging. Although the events leading to DD are not well understood, a significant genetic influence has been found. This study was undertaken to assess the association between relevant candidate gene polymorphisms and moderate DD in a well-defined and characterized cohort of young adults. Focusing on young age can be valuable in determining genetic predisposition to DD. METHODS: We investigated the associations of existing candidate genes for DD among 538 young adults with a mean age of 19 belonging to the 1986 Northern Finland Birth Cohort. Nineteen single nucleotide polymorphisms (SNP) in 16 genes were genotyped. We evaluated lumbar DD using the modified Pfirrmann classification and a 1.5-T magnetic resonance scanner for imaging. RESULTS: Of the 538 individuals studied, 46% had no degeneration, while 54% had DD and 51% of these had moderate DD. The risk of DD was significantly higher in subjects with an allele G of IL6 SNPs rs1800795 (OR 1.45, 95% CI 1.07-1.96) and rs1800797 (OR 1.37, 95% CI 1.02-1.85) in the additive inheritance model. The role of IL6 was further supported by the haplotype analysis, which resulted in an association between the GGG haplotype (SNPs rs1800797, rs1800796 and rs1800795) and DD with an OR of 1.51 (95% CI 1.11-2.04). In addition, we observed an association between DD and two other polymorphisms, SKT rs16924573 (OR 0.27 95% CI 0.07-0.96) and CILP rs2073711 in women (OR 2.04, 95% CI 1.07-3.89). CONCLUSION: Our results indicate that IL6, SKT and CILP are involved in the etiology of DD among young adults.

Genetic risk factors of disc degeneration among 12-14-year-old Danish children: a population study.

The objective of the present study was to examine the associations between eleven putative predisposing single nucleotide polymorphisms (COL9A3, COL11A2, IL1A, IL1B, IL6 and VDR) and early disc degeneration (DD). The population consisted of 12 to 14-year-old Danish children (N=352). DD was evaluated from magnetic resonance images (MRI). We analysed the association between DD and single nucleotide polymorphisms or haplotypes using logistic regression analyses. Of the 352 children studied, 73 boys and 81 girls had no MRI changes, while 30 boys and 36 girls had lumbar DD. Among girls, IL1A rs1800587 in CT/TT compared to CC resulted in OR 2.85 [1.19-6.83]. In IL6 promoter polymorphism rs1800796, the C-allele was more frequent among the subjects with DD, OR 6.71 [1.71-26.3]. Of the IL6 haplotypes, GCG was associated with DD, OR 6.46 [1.61 - 26.0]. No associations were observed among boys. Our results suggest possible roles for IL1A and IL6 in early DD among girls.

Genetic factors are associated with modic changes in endplates of lumbar vertebral bodies.

STUDY DESIGN: A cross-sectional genotype-phenotype evaluation. OBJECTIVE: To evaluate the genetic background to Modic changes in an occupational cohort. SUMMARY OF BACKGROUND DATA: Modic changes are vertebral endplate changes visible in magnetic resonance imaging. Twin studies suggest that intervertebral disc degeneration may be primarily explained by genetic factors, but no data exist on genetic factors of Modic changes. METHODS: Thirteen variations in 8 genes (COL9A2, COL9A3, COL11A2, IL1A, IL1B, IL6, MMP3, and VDR) were genotyped in an occupational cohort of 159 male train engineers and 69 male paper mill workers. All the subjects were scanned by magnetic resonance imaging and evaluated for Modic changes. RESULTS: Out of the 228 subjects, 128 (56%) were found to have Modic changes at one or more disc levels, exclusively of type I in 15%, of type II in 32%, and of both type I and type II in 10%. None of the single nucleotide polymorphisms was significantly associated with Modic changes when analyzed independently, but when gene-gene interactions were evaluated, interleukin-1A (IL1A) and matrix metalloproteinase-3 (MMP3) polymorphisms together were associated with type II Modic changes (OR = 3.2, 95% CI = 1.2-8.5; P = 0.038), as was the IL1 gene cluster together with the MMP3 polymorphism (OR = 8.14, 95% CI = 1.72-38.44; P = 0.008). DISCUSSION: This is the first study evaluating the role of genetic factors in relation to Modic changes. Genetic variations in the IL1 cluster and the MMP3 gene together were found to be significantly associated with type II Modic changes.

Is the interleukin-6 haplotype a prognostic factor for sciatica?

AIMS: We have shown in a cross-sectional setting that an IL6 haplotype (GGGA) is associated with intervertebral disc disease (IDD) characterized by sciatica. The aim of this study was to evaluate the prognostic role of the GGGA haplotype in IDD. METHODS: DNA from 153 sciatica patients who participated in a randomized controlled trial of periradicular infiltration was analysed for IL6 variations rs1800797 (-596A>G), rs1800796 (-572G>C), rs1800795 (-174G>C), and rs13306435 (+15T>A). The patients recorded back and leg pain intensity and duration, disability by Oswestry Index and back-related sickness absence over a three-year follow-up. Repeated measures and univariate analysis of variance with adjustment for age, gender and physical work load were used in statistical analyses for the last two-years of the follow-up. RESULTS: The prevalence of the GGGA haplotype was 9% (14/153). Subjects with the GGGA haplotype did not differ from those without the haplotype with respect to pain intensity, or disability score, but days with back and leg pain and days on sick leave were significantly higher among subjects with the IL6 haplotype after adjustment for occupation (p=0.006, 0.001 and 0.002, respectively). An interaction between the IL6 haplotype and physical work load was significant for the duration of back and leg pain and sick leave (p=0.038, 0.011 and 0.006, respectively). CONCLUSIONS: This is the first observation of any prognostic genotype among sciatica patients. The IL6 haplotype GGGA predicted the number of days with back or leg pain and also sickness absence. Subjects with the IL6 haplotype may be more vulnerable when doing physically demanding jobs.