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BackgroundBraces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.MethodOne hundred twenty-six men and women aged 40–70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts’s equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman’s correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.ResultsMean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA − 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.ConclusionThe reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.Trial registrationTrial registration number UK. ISRCTN50380458/Registered 21.5.2010.

SUMMARYThis case was rather unusual with regard to the disease presentation. The patient had non-specific symptoms of weight loss and general malaise, without any history of preceding diarrhoea or dysentery. It is important to be aware of the epidemiology of the disease, and to relate it to patients presenting with symptoms suggestive of amoebiasis. We discuss the recommended investigations and management options for these patients based on the current guidelines/evidence. BACKGROUND

The thread lift is becoming an increasingly popular treatment within the field of aesthetic medicine. The procedure can be performed using polydioxanone (PDO) threads to lift, tighten and rejuvenate areas of sagging skin, and minimise fatty tissue. This allows for the non-surgical redefinition of facial contours and enhancement of skin integrity. Thread lifting with PDO can also provide certain aspects of the much sought after surgical facelift in a clinic setting. PDO threads aim to promote targeted lipolysis of fatty areas and neocollagenesis in sagging skin, as well as lift the treated areas. However, it is important to note that the extent of these enhancements varies between individuals, and can carry unwanted side effects. The author draws on his experience to discuss the importance of managing patient expectations pre and post PDO thread lifting, describe the treatment's mechanisms of action, and highlight important considerations for aesthetic practitioners who wish to pursue these treatments.

Breast cancer is a major cause of mortality worldwide. As the population ages and life expectancy increases, the burden of cancer on health services will increase. Older patients with breast cancer are becoming more suitable for surgery; tailored surgical techniques and increasing healthy life expectancy alongside improved assessment of patients are aiding this trend. Surgery is also becoming a favoured treatment of personal choice for older patient with breast cancer. Evidence shows that surgery is almost always feasible for the older patient with outcomes (survival, progression, and recurrence rates) comparable to younger groups and superior to nonsurgical treatments. We aim to describe the current status of surgery for the older patient with breast cancer, showing it is an option that should not be denied. Surgery should always be considered regardless of age, after evaluation of comorbidities.