Patient age and comorbidity have been found to increase the length of hospital stay (LOS), readmissions, and mortality after surgery, including in elective primary total hip arthroplasty (THA) and ...total knee arthroplasty (TKA). Whether the same applies in fast-track THA and TKA with early mobilization and an LOS aim of 2–4 days remains unanswered.
A prospective study on patient characteristics and comorbidity in consecutive unselected patients undergoing fast-track THA and TKA was cross-referenced with the Danish National Health Registry and medical charts allowing complete 90 days follow-up.
A total of 3112 THA/TKAs were performed in 3020 patients. The mean age was 67 (range 18–97) years. The median LOS was 3 (inter-quartile range: 1) and the mean 3.0 days (range 1–34), with 91% having LOS ≤4 days. Age 76–80 odds ratio (OR): 1.57; 95% confidence interval (CI): 0.99–2.47, 81–85 (OR: 2.40; 1.45–4.00), and >85 yr (OR: 4.10; 2.15–7.82), preoperative cardiopulmonary disease (CPD) (OR: 1.40; 1.03–1.91), preoperative use of a mobility aid (OR: 1.95; 1.46–2.54), and living conditions (OR: 1.92; 1.44–2.54) were related to LOS >4 days. However, more than 75% of those aged over 80 yr or with these conditions had an LOS ≤4 days. Mortality and readmission rate were 0.22% and 6.6%, respectively, at 30 days and 0.42% and 9.3% at 90 days. Readmissions were similarly related to older age, CPD, and use of mobility aids.
Fast-track THA and TKA with LOS of ≤4 days and discharge to home is feasible and safe, including in elderly patients with comorbidities.
We present high-precision photometry of two transit events of the extrasolar planetary system WASP-5, obtained with the Danish 1.54-m telescope at European Southern Obseratory La Silla. In order to ...minimize both random and flat-fielding errors, we defocused the telescope so its point spread function approximated an annulus of diameter 40 pixel (16 arcsec). Data reduction was undertaken using standard aperture photometry plus an algorithm for optimally combining the ensemble of comparison stars. The resulting light curves have point-to-point scatters of 0.50 mmag for the first transit and 0.59 mmag for the second. We construct detailed signal-to-noise ratio calculations for defocused photometry, and apply them to our observations. We model the light curves with the jktebop code and combine the results with tabulated predictions from theoretical stellar evolutionary models to derive the physical properties of the WASP-5 system. We find that the planet has a mass of Mb= 1.637 ± 0.075 ± 0.033 MJup, a radius of Rb= 1.171 ± 0.056 ± 0.012 R Jup, a large surface gravity of gb= 29.6 ± 2.8 m s−2 and a density of ρb= 1.02 ± 0.14 ± 0.01 ρJup (statistical and systematic uncertainties). The planet's high equilibrium temperature of Teq= 1732 ± 80 K makes it a good candidate for detecting secondary eclipses.
Methanol is a key species in astrochemistry because it is the most abundant organic molecule in the interstellar medium and is thought to be the mother molecule of many complex organic species. ...Estimating the deuteration of methanol around young protostars is of crucial importance because it highly depends on its formation mechanisms and the physical conditions during its moment of formation. We analyse several dozen transitions from deuterated methanol isotopologues coming from various existing observational datasets obtained with the IRAM-PdBI and ALMA sub-millimeter interferometers to estimate the methanol deuteration surrounding three low-mass protostars on Solar System scales. A population diagram analysis allows us to derive a CH2DOH/CH3OH abundance ratio of 3–6% and a CH3OD/CH3OH ratio of 0.4–1.6% in the warm inner (≤100–200 AU) protostellar regions. These values are typically ten times lower than those derived with previous single-dish observations towards these sources, but they are one to two orders of magnitude higher than the methanol deuteration measured in massive hot cores. Dust temperature maps obtained from Herschel and Planck observations show that massive hot cores are located in warmer molecular clouds than low-mass sources, with temperature differences of ~10 K. The comparison of our measured values with the predictions of the gas-grain astrochemical model GRAINOBLE shows that such a temperature difference is sufficient to explain the different deuteration observed in low- to high-mass sources. This suggests that the physical conditions of the molecular cloud at the origin of the protostars mostly govern the present-day observed deuteration of methanol and therefore of more complex organic molecules. Finally, the methanol deuteration measured towards young solar-type protostars on Solar System scales seems to be higher by a factor of ~5 than the upper limit in methanol deuteration estimated in comet Hale-Bopp. If this result is confirmed by subsequent observations of other comets, it would imply that an important reprocessing of the organic material likely occurred in the solar nebula during the formation of the Solar System.
Previous studies have demonstrated widespread exposure of humans to certain benzophenones commonly used as UV filters or UV absorbers; some of which have been demonstrated to have endocrine ...disrupting abilities.
To examine whether benzophenones present in pregnant women pass through the placental barrier to amniotic fluid and further to the fetal blood circulation.
A prospective study of 200 pregnant women with simultaneously collected paired samples of amniotic fluid and maternal serum and urine. In addition, unique samples of human fetal blood (n=4) obtained during cordocentesis: and cord blood (n=23) obtained at delivery, both with paired maternal samples of serum and urine collected simultaneously, were used. All biological samples were analyzed by TurboFlow-liquid chromatography - tandem mass spectrometry for seven different benzophenones.
Benzophenone-1 (BP-1), benzophenone-3 (BP-3), 4-methyl-benzophenone (4-MBP), and 4-hydroxy-benzophenone (4-HBP) were all detectable in amniotic fluid and cord blood samples and except 4-HBP also in fetal blood; albeit at a low frequency. BP-1 and BP-3 were measured at ~10-times lower concentrations in fetal and cord blood compared to maternal serum and 1000-times lower concentration compared to maternal urine levels. Therefore BP-1 and BP-3 were only detectable in the fetal circulation in cases of high maternal exposure indicating some protection by the placental barrier. 4-MBP seems to pass into fetal and cord blood more freely with a median 1:3 ratio between cord blood and maternal serum levels. Only for BP-3, which the women seemed to be most exposed to, did the measured concentrations in maternal urine and serum correlate to concentrations measured in amniotic fluid. Thus, for BP-3, but not for the other tested benzophenones, maternal urinary levels seem to be a valid proxy for fetal exposure.
Detectable levels of several of the investigated benzophenones in human amniotic fluid as well as in fetal and cord blood calls for further investigations of the toxicokinetic and potential endocrine disrupting properties of these compounds in order for better assessment of the risk to the developing fetus.
•Several benzophenones are detectable in amniotic fluid, fetal- and cord blood.•Significant correlation was found between BP-3 in maternal urine and amniotic fluid indication that BP-3 in maternal urine is a valid proxy for fetal exposure.•BP-1 and BP-3 are detectable in cord blood only in cases of high maternal exposure.•4-MBP seem to pass more freely from mother into fetus.
Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated.
From ...October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125 mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery. An unadjusted comparison was specifically done to evaluate deep prosthetic infections.
Of a total of 3927 TKA procedures, 1442 received MP. Median LOS was 2 days in both groups, but the fraction with LOS >4 days was 6.0% vs 11.5% (P<0.001) in patients with MP vs those without, and with a reduced risk of LOS >4 days in adjusted analysis odds ratio (OR) 0.51; confidence interval (CI) 0.39–0.68; P<0.001. Readmission rates were 5.6% (CI 4.5–6.9) vs 4.4% (P=0.095) and 7.8% vs 7.3% (P=0.53) at 30 and 90 days with and without MP, respectively.
Adjusted analysis did not identify MP to be associated with 30 day (OR 1.18; CI 0.89–1.56; P=0.25) or 90 day (OR 1.12; CI 0.86–1.46; P=0.39) readmissions. The incidence of deep infections requiring surgical intervention was 0.8% vs 0.7% with MP vs without, respectively (P=0.78).
In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS >4 days, readmissions or infectious complications in TKA patients without contraindications.
NCT01515670.
Much of the Earth's biosphere has been appropriated for the production of harvestable biomass in the form of food, fuel and fibre. Here we show that the simplification and intensification of these ...systems and their growing connection to international markets has yielded a global production ecosystem that is homogenous, highly connected and characterized by weakened internal feedbacks. We argue that these features converge to yield high and predictable supplies of biomass in the short term, but create conditions for novel and pervasive risks to emerge and interact in the longer term. Steering the global production ecosystem towards a sustainable trajectory will require the redirection of finance, increased transparency and traceability in supply chains, and the participation of a multitude of players, including integrated 'keystone actors' such as multinational corporations.
Vascular smooth muscle cells (VSMCs) are a major cell type present at all stages of an atherosclerotic plaque. According to the 'response to injury' and 'vulnerable plaque' hypotheses, contractile ...VSMCs recruited from the media undergo phenotypic conversion to proliferative synthetic cells that generate extracellular matrix to form the fibrous cap and hence stabilize plaques. However, lineage-tracing studies have highlighted flaws in the interpretation of former studies, revealing that these studies had underestimated both the content and functions of VSMCs in plaques and have thus challenged our view on the role of VSMCs in atherosclerosis. VSMCs are more plastic than previously recognized and can adopt alternative phenotypes, including phenotypes resembling foam cells, macrophages, mesenchymal stem cells and osteochondrogenic cells, which could contribute both positively and negatively to disease progression. In this Review, we present the evidence for VSMC plasticity and summarize the roles of VSMCs and VSMC-derived cells in atherosclerotic plaque development and progression. Correct attribution and spatiotemporal resolution of clinically beneficial and detrimental processes will underpin the success of any therapeutic intervention aimed at VSMCs and their derivatives.
Abstract Some anti-diabetic therapies can have adverse effects on bone health and increase fracture risk. In this study, we tested the skeletal effects of chronic administration of two Glucagon-like ...peptide-1 receptor agonists (GLP-1RA), increasingly used for type 2 diabetes treatment, in a model of osteoporosis associated bone loss and examined the expression and activation of GLP-1R in bone cells. Mice were ovariectomised (OVX) to induce bone loss and four weeks later they were treated with Liraglutide (LIR) 0.3 mg/kg/day, Exenatide (Ex-4) 10 μg/kg/day or saline for four weeks. Mice were injected with calcein and alizarin red prior to euthanasia, to label bone-mineralising surfaces. Tibial micro-architecture was determined by micro-CT and bone formation and resorption parameters measured by histomorphometric analysis. Serum was collected to measure calcitonin and sclerostin levels, inhibitors of bone resorption and formation, respectively. GLP-1R mRNA and protein expression were evaluated in the bone, bone marrow and bone cells using RT-PCR and immunohistochemistry. Primary osteoclasts and osteoblasts were cultured to evaluate the effect of GLP-1RA on bone resorption and formation in vitro. GLP-1RA significantly increased trabecular bone mass, connectivity and structure parameters but had no effect on cortical bone. There was no effect of GLP-1RA on bone formation in vivo but an increase in osteoclast number and osteoclast surfaces was observed with Ex-4. GLP-1R was expressed in bone marrow cells, primary osteoclasts and osteoblasts and in late osteocytic cell line. Both Ex-4 and LIR stimulated osteoclastic differentiation in vitro but slightly reduced the area resorbed per osteoclast. They had no effect on bone nodule formation in vitro. Serum calcitonin levels were increased and sclerostin levels decreased by Ex-4 but not by LIR. Thus, GLP-1RA can have beneficial effects on bone and the expression of GLP-1R in bone cells may imply that these effects are exerted directly on the tissue.
We submit that the safe operating space of the planetary boundary of novel entities is exceeded since annual production and releases are increasing at a pace that outstrips the global capacity for ...assessment and monitoring. The novel entities boundary in the planetary boundaries framework refers to entities that are novel in a geological sense and that could have large-scale impacts that threaten the integrity of Earth system processes. We review the scientific literature relevant to quantifying the boundary for novel entities and highlight plastic pollution as a particular aspect of high concern. An impact pathway from production of novel entities to impacts on Earth system processes is presented. We define and apply three criteria for assessment of the suitability of control variables for the boundary: feasibility, relevance, and comprehensiveness. We propose several complementary control variables to capture the complexity of this boundary, while acknowledging major data limitations. We conclude that humanity is currently operating outside the planetary boundary based on the weight-of-evidence for several of these control variables. The increasing rate of production and releases of larger volumes and higher numbers of novel entities with diverse risk potentials exceed societies’ ability to conduct safety related assessments and monitoring. We recommend taking urgent action to reduce the harm associated with exceeding the boundary by reducing the production and releases of novel entities, noting that even so, the persistence of many novel entities and/or their associated effects will continue to pose a threat.
A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of ...cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat, or blurred vision. We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy.
Orthostatic tolerance and the cardiovascular response to sitting and standing were evaluated on the day before surgery and 6 and 22 h after operation in 16 patients. Non-invasive systolic (SAP) and diastolic arterial pressure (DAP) (Finometer®), heart rate, cardiac output (CO, Modelflow®), total peripheral resistance (TPR), and central venous oxygen saturation (Scvo2) were monitored.
Before surgery, no patients had symptoms of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and ∼22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P<0.05), whereas CO did not change (P>0.05) and Scvo2 decreased (P<0.05) upon mobilization. At 6 h after operation, SAP and DAP declined with mobilization (P<0.05) and the arterial pressure response differed from the preoperative response both upon sitting (P<0.05) and standing (P<0.05) due to both impaired TPR and CO. At ∼22 h, the SAP and DAP responses to mobilization did not differ from the preoperative evaluation (P>0.05).
The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses.
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