Norovirus disease associated with excess mortality and use of statins: a retrospective cohort study of an outbreak following a pilgrimage to Lourdes.

Although norovirus infection is generally known to be a mild disease, there is some evidence for severe outcome. An outbreak in a Dutch psychiatric institution, originating from pilgrims returning from Lourdes (France), provided an opportunity for performing a retrospective cohort study in order to identify risk factors for norovirus disease and excess mortality. Relative risks (RR) including 95% confidence intervals (CI) showed that attending the pilgrimage (RR 2·0, 95% CI 1·4-3·0) and age >70 (RR 1·7, 95% CI 1·2-2·2) were risk factors for symptomatic infection. In a subset of patients, for whom more detailed information was available, the use of statins was associated with norovirus disease when adjusted for underlying condition (adjusted odds ratio 3·9, 95% CI 1·2-13·0). Mortality was higher in cases infected during the pilgrimage compared to other residents (RR 20·9, 95% CI 4·7-93·8). Norovirus disease can lead to severe outcome. The newly identified risk of statins for contracting norovirus disease may have considerable consequences for the Western world and needs prospective confirmation.

Immunity to poliomyelitis in The Netherlands.

Despite a vaccination coverage rate of 97%, several poliomyelitis outbreaks occurred in the Netherlands during the last three decades, all among sociogeographically clustered, unvaccinated persons. Therefore, to eradicate polio, insight into poliomyelitis immunity is particularly useful. In 1995-1996, the authors conducted a population-based study and determined neutralizing antibodies against poliovirus types 1, 2, and 3 in 9,274 sera from the general population and from religious groups rejecting vaccination. In the general population, the antibody prevalence (>/=1:8) was 96.6% (95% confidence interval (CI): 95.9, 97.2), 93.4% (95% CI: 92.3, 94.5), and 89.7% (95% CI: 88.3, 91.0) for poliovirus types 1, 2, and 3, respectively. Antibodies persisted for long periods in persons with natural immunity as well as in persons whose immunity was induced by inactivated polio vaccine. In Orthodox Reformed persons, the antibody prevalence of poliovirus types 1, 2, and 3 was 65.0% (95% CI: 57.2, 72.9), 59.0% (95% CI: 40.1, 77.9), and 68.7% (95% CI: 65.2, 72.2), respectively. The recent outbreaks clearly affected the seroprevalence profiles of Orthodox Reformed groups but not the general population. At present, there is an insufficient social and political basis for mandatory vaccination; therefore, global eradication of poliovirus seems to be the only way to protect these Orthodox Reformed persons against future poliomyelitis outbreaks.

Ground reaction forces in horses, assessed from hoof wall deformation using artificial neural networks.

An artificial neural network (ANN) was developed to investigate whether hoof wall deformation could be used to determine ground reaction forces (GRF) in horses. The ANN was taught this relationship under certain conditions and was able to generalise this knowledge to conditions for which it was not trained before. To acquire data to train and test the ANN, a horse was equipped with strain gauges attached to the dorsal, lateral and medial parts of the hoof to assess hoof wall deformation. A force plate was used to measure the GRFs. Both hoof wall deformation and GRF were recorded simultaneously at different speeds, gaits, surfaces and loads. An ANN was trained with some of these data, and subsequently provided with strain gauge recordings of strides, not used for training. By comparing the GRF calculated by the ANN based on the hoof wall deformation with that recorded simultaneously by the force plate, the generalisability of the ANN was determined. It was found that an ANN is capable of 'learning' the relationship between hoof wall deformation and GRF, and to generalise it to a wide range of new conditions. This technique enables assessment of GRF under difficult conditions, such as on a treadmill or on surfaces where a force plate cannot be employed.

Pain after use of the central third of the patellar tendon for cruciate ligament reconstruction. 33 patients followed 2-3 years.

We performed reconstruction of the anterior cruciate ligament in 33 patients using the central third of the patellar tendon. In 20 patients we did an arthroscopically-assisted procedure, while 13 patients had an additional mini-arthrotomy through the gap in the patellar tendon. After 2-3 years the subjective knee function, according to the Lysholm score, was excellent or good in 18 knees and fair or poor in 15 knees, mainly due to anterior knee pain. Although 18 patients complained about anterior knee pain, only 1 patient required further surgery. After the operation the patella had a lower position. A flexion contracture was found in 7 patients, and 13 had heterotopic bone formation at the apex of the patella. Although stability was restored in 31 of the 33 reconstructed knees, anterior knee pain was a frequent complication. There were no correlations between the anterior knee pain and patellar height, flexion contracture or heterotopic bone formation.

A fracture of the intercondylar eminence of the tibia treated by arthroscopic fixation.

A fracture of the intercondylar eminence of the tibia in a 27-year-old woman was treated arthroscopically, using the Acufex (Acufex Microsurgical, Inc., U.S.A.) drill guide system for anterior cruciate ligament reconstructions. An adequate fixation was achieved, and an arthrotomy was avoided. The patient recovered quickly, with no residual symptoms. We recommend performing an arthroscopy in every patient with a fracture of the intercondylar eminence. The fracture can be treated arthroscopically by rigid internal fixation, while at the same time treating possible associated lesions.