Summary
The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or ...osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.
Introduction
To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.
Methods
We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.
Results
The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1–17 years). The use of BPs was significantly associated with AFFs (
p
< 0.001, odds ratio = 25.65; 95% confidence interval = 10.74–61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.
Conclusions
The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.
Edge localized modes (ELMs) in high-confinement mode plasmas were completely suppressed in KSTAR by applying n=1 nonaxisymmetric magnetic perturbations. Initially, the ELMs were intensified with a ...reduction of frequency, but completely suppressed later. The electron density had an initial 10% decrease followed by a gradual increase as ELMs were suppressed. Interesting phenomena such as a saturated evolution of edge T(e) and broadband changes of magnetic fluctuations were observed, suggesting the change of edge transport by the applied magnetic perturbations.
The emergence of the H7N9 influenza virus in humans in Eastern China has raised concerns that a new influenza pandemic could occur. Here, we used a ferret model to evaluate the infectivity and ...transmissibility of A/Shanghai/2/2013 (SH2), a human H7N9 virus isolate. This virus replicated in the upper and lower respiratory tracts of the ferrets and was shed at high titers for 6 to 7 days, with ferrets showing relatively mild clinical signs. SH2 was efficiently transmitted between ferrets via direct contact, but less efficiently by airborne exposure. Pigs were productively infected by SH2 and shed virus for 6 days but were unable to transmit the virus to naïve pigs or ferrets. Under appropriate conditions, human-to-human transmission of the H7N9 virus may be possible.
The Mass Absorption Cross section (MAC) and Absorption Ångström Exponent (AAE) have been commonly estimated for ambient aerosols but rarely for black carbon (BC) or organic aerosol (OA) alone in the ...ambient conditions. Here, we provide estimates of BC (and OA) MAC and AAE in East Asian outflow, by analyzing field data collected at the Gosan ABC super site. At this site, EC (and OC) carbon mass, the aerosol absorption coefficient at 7 wavelengths and PM mass density were continuously measured from October 2009 to June 2010. We remove the absorption data with significant dust influence using the mass ratio of PM10 to PM2.5. The remaining data shows an AAE of about 1.27, which we suggest represent the average carbonaceous aerosol (CA) AAE at Gosan. We find a positive correlation between the mass ratio of OC to EC and CA AAE, and successfully increase the correlation by filtering out data associated with weak absorption signal. After the filtering, absorption coefficient is regressed on OC and EC mass densities. BC and OA MACs are found to be 5.1 (3.8–6.1) and 1.4 (0.8–2.0) m2 g−1 at 520 nm respectively. From the estimated BC and OA MAC, we find that OA contributes about 45% to CA absorption at 520 nm. BC AAE is found to be 0.7–1.0, and is probably even lower considering the instrument bias. OA AAE is found to be 1.6–1.8. Compared with a previous estimate of OA MAC and AAE near biomass burning, our estimates at Gosan strongly suggest that the strongly-absorbing so-called brown carbon spheres are either unrelated to biomass burning or absent near the emission source.
Although the critical role of alkaline phosphatase in bone mineralization is clearly understood, the potentially adverse effect of high alkaline phosphatase levels on the cardiovascular system was ...only recently suggested. In this study, we hypothesized that increased levels of serum alkaline phosphatase may be associated with poor outcome after stroke in terms of mortality.
We prospectively included patients with acute stroke admitted consecutively to our hospital, from October 2002 to September 2008. A total of 2,029 patients were selected for the analyses. In the analyses of mortality, the patients were divided by baseline measurements into quintiles of alkaline phosphatase levels (<57, 57-69, 70-81, 82-97, >97 IU/L).
In the Cox proportional hazard models, compared with the first alkaline phosphatase quintile, adjusted hazard ratios of the third, fourth, and fifth quintiles for all-cause death were 1.67 (95% confidence interval 1.12-2.49), 1.79 (1.20-2.67), and 2.83 (1.95-4.10). When we divided the patients into ischemic and hemorrhagic stroke, the association was also significant for both subtypes of stroke. In terms of vascular death, compared to the first alkaline phosphatase quintile, the adjusted hazard ratios of the fourth and fifth quintiles of alkaline phosphatase were 1.81 (95% confidence interval 1.14-2.86) and 2.78 (1.87-4.15).
Our study demonstrated that increased serum levels of alkaline phosphatase are an independent predictor of all-cause and vascular death after either ischemic or hemorrhagic stroke.
We conducted a systemic evaluation to describe the effect of minimal residual disease (MRD) kinetics on long-term allogeneic transplantation outcome by analyzing 95 adult transplants with ...Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL) who received first-line two courses of imatinib-based chemotherapy (median follow-up 5 years). MRD monitoring was centrally evaluated by real-time quantitative PCR (4.5 log sensitivity). After the first course of imatinib-based chemotherapy, 33 patients (34.7%) achieved at least major molecular response. On the basis of MRD kinetics by the end of two courses of imatinib-based chemotherapy, we stratified entire patients into four subgroups: early-stable molecular responders (EMRs, n=33), late molecular responders (LMRs, n=35), intermediate molecular responders (IMRs, n=9) and poor molecular responders (PMRs, n=18). Multivariate analysis showed that the most powerful factor affecting long-term transplantation outcome was MRD kinetics. Compared with EMRs, IMRs or PMRs had significantly higher risk of treatment failure in terms of relapse and disease-free survival (DFS). LMRs had a tendency toward a lower DFS. Quantitative monitoring of MRD kinetics during the first-line imatinib-based chemotherapy course is useful in identifying subgroups of Ph-positive ALL transplants at a high risk of relapse.
It is unclear whether the amount of sodium consumed and the degree of saltiness of food is associated with obesity. We examined the association between sodium intake and obesity using the concept of ...sodium density.
This study included 5025 children (7-18 years) and 20586 adults (≥ 19 years) who participated in the Korean National Health and Nutrition Examination Survey(KNHANES), 2007-2010. We defined sodium density(mg/g) as the ratio of daily dietary sodium intake (mg/day) and daily food weight consumed (g/day). We examined the association between sodium density and obesity, and abdominal obesity in children and adults.
The overall prevalences of obesity and abdominal obesity were 31.4 and 24.5%, respectively, in adults and 4.5 and 6.5%, respectively, in children. The multivariate-adjusted odds ratio (OR) for obesity in adults with the highest quintile of sodium density compared with the lowest quintile was 1.18 (95% confidence interval (CI), 1.04-1.35), and a significant dose-response association (P for trend=0.002) was observed. The OR for abdominal obesity in adults with the highest quintile of sodium density was not statistically significant after adjusting for confounding factors, but showed a significant dose-response association (P for trend=0.043). In children, OR values for obesity and abdominal obesity in the highest quintile of sodium density were 1.78 (95% CI, 1.13-2.80) and 2.13 (95% CI, 1.16-3.91), respectively, and both showed significant dose-response associations (P for trend <0.001).
Our results indicate that high sodium intake may be a potential risk factor for weight gain independent of calorie intake.
To investigate the risk factors for acute GVHD (aGVHD), based on NIH consensus criteria (NCC), we evaluated 775 patients who underwent allogeneic transplantation. Of them, 346 patients developed ...aGVHD by NCC, in whom we also analyzed factors affecting aGVHD-specific survival. The cumulative incidence of aGVHD was 44.7%, consisting of classic aGVHD (n=320) and late-onset (n=26). Multivariate analyses revealed that younger age (P=0.015), unrelated donors (P=0.004) and acute leukemia compared with other hematologic malignancies (P=0.005) were significant risk factors for aGVHD, whereas PBSCs showed no association (P=0.720). Multivariate analyses, with only aGVHD patients, revealed that late-onset aGVHD had superior aGVHD-specific survival to classic aGVHD (P=0.044), and identified the association of visceral organ involvement (P=0.002), severity of aGVHD at onset (P=0.035) and advanced disease status (P<0.001) with inferior aGVHD-specific survival. In conclusion, this study demonstrates the risk and prognostic factors for aGVHD by NCC with some differences with the previous reports that were based on old criteria. The difference in the risk factors according to different criteria will give insights about the pathophysiology of GVHD. The better prognosis of late-onset aGVHD than of classic aGVHD raises the necessity for prospective trials with a large cohort focusing on the onset time.
Background
Laparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in ...many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy.
Methods
From February 1995 to March 2006, 31 patients underwent laparoscopic distal pancreatectomy, and 167 patients underwent open distal pancreatectomy at Seoul National University Hospital and Bundang Seoul National University Hospital. A case–control design was used with 2:1 matching to compare laparoscopic surgery with open surgery. Among 167 patients who underwent open distal pancreatectomy, 62 patients whose age, gender, and pathology were similar to those of patients who underwent laparoscopic surgery were selected for this study. The operation time, intraoperative transfusion requirements, duration of postoperative hospitalization, complications, mortality, recurrence, and hospital charges were analyzed.
Results
There were no significant differences in operation time, rate of intraoperative transfusions, complications, recurrence, or mortality between the two groups. Laparoscopic distal pancreatectomy was associated with a statistically significant shorter hospital stay (11.5 days vs 13.5 days;
p
= 0.049), but with more expensive hospital charges than open distal pancreatectomy (
p
< 0.01).
Conclusion
Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.
Background Although remifentanil provides profound analgesia during operation, postoperative occurrence of hyperalgesia and tolerance after remifentanil administration could be a challenge to the ...postoperative pain control. In this investigation, we sought to determine the effect of maintenance with propofol or sevoflurane on postoperative analgesia after remifentanil-based anaesthesia. Methods Two hundred and fourteen women undergoing breast cancer surgery under remifentanil-based general anaesthesia were randomly included in this prospective and double-blind trial. The patients were anaesthetized with sevoflurane (S) or propofol (P) under high (H) or low (L) effect-site concentration (Ce) of remifentanil-based anaesthesia using a target-controlled infusion system; the patients were allocated into the SH, SL, PH, and PL groups. Pain intensity (visual analogue score, VAS) and cumulative morphine requirements were recorded 30 min, 1, 6, 12, and 24 h after operation. Results The patient characteristics were similar. Cumulative morphine consumption at 24 h after surgery was higher in the SH group 38.6 (sd 14.9) compared with the SL 31.5 (3.7), PH 31.7 (8.3), and PL groups 30.1 (6.1) (P<0.001). The VAS scores during 24 h after surgery were also higher in the SH group than the SL, PH, and PL groups (P<0.001). Conclusions Remifentanil hyperalgesia was induced by high dose of remifentanil-based anaesthesia during sevoflurane anaesthesia, whereas that was not apparent during propofol anaesthesia. Also, remifentanil hyperalgesia did not occur during low dose of remifentanil-based anaesthesia. Maintenance of propofol during high-dose remifentanil-based anaesthesia provided better postoperative analgesia.
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