Osteoporosis remains an underrecognized and undertreated disease entity in the orthopaedic setting, accounting for substantial long-term morbidity and mortality. Osteoporosis is often not diagnosed ...or treated until multiple fractures have occurred. Vertebral compression fractures are the most common sentinel fracture, providing an opportunity to intervene with antiresorptive therapy before more debilitating fractures occur. Little data has been published on osteoporosis screening and treatment following vertebral fractures. Further elucidation of the osteoporosis care gap in these patients is warranted.
To demonstrate the current state of post vertebral fracture osteoporosis management at a large tertiary care center with no established secondary fracture prevention program.
Retrospective cohort study.
A large tertiary care hospital or one of its affiliated community hospitals.
All 2,933 patients, 50 years of age or older, who presented to an emergency department with a new vertebral fracture between 2008 and 2014.
The physiological measures are rates of new fractures within 2 years following first vertebral fracture.
Post vertebral fracture rates of dual energy X-ray absorptiometry (DXA) testing, calcium and vitamin D supplementation, and pharmacotherapy for osteoporosis within 1 year postfracture, and more than 1 year postfracture. Linear trend of the rate of new antiosteoporosis pharmacotherapy among previously antiosteoporosis medication naive patients within 1 year of fracture over time from 2008 to 2014.
All patients aged 50 years or older presenting to an emergency department with a vertebral fracture between 2008 and 2014 were included. Only an individual's first documented vertebral fracture was considered. Individuals were assessed for DXA screening, calcium and vitamin D supplementation, treatment with an antiosteoporosis medication, and additional fractures following incident vertebral fracture. Statistical analyses included descriptive statistics and a simple logistic regression. No specific funding was provided for this study. The authors of this study report no relevant financial conflicts of interests or associated biases.
Between 2008 and 2014, 2,933 unique patients were seen at an included emergency department for one or more vertebral fracture encounters. Ninety-eight percent did not receive a DXA scan within the preceding 2 years or 1 year following fracture. Seven percent of patients were started on antiresorptive therapy after their fracture, with 341 (5%) starting within 1 year of fracture and 211 (2%) starting thereafter. Twenty-one percent (n=616) had taken an antiresorptive medication before their fracture. Seventy three percent (n=2,128) were never prescribed antiresorptive therapy. Treatment rates slightly decreased over time. Thirty eight percent of patients presenting with a vertebral fracture (n=1,115) went on to develop a second fragility fracture within 2 years.
In the absence of a specific local program to improve secondary fracture prevention following minimal trauma spinal fractures, recognition and treatment of osteoporosis in patients at this institution remained dismal over time despite numerous calls to action on the topic in the orthopaedic literature and elsewhere. Undertreatment of osteoporosis puts patients at increased risk of incurring additional fractures. Within 2 years, 38% of the patients in this sample developed an additional fragility fracture. This study demonstrates a profound post vertebral fracture osteoporosis care gap.
ABSTRACT
The repeating fast radio burst (FRB) source FRB 20200120E is exceptional because of its proximity and association with a globular cluster. Here we report 60 bursts detected with the ...Effelsberg telescope at 1.4 GHz. We observe large variations in the burst rate, and report the first FRB 20200120E ‘burst storm’, where the source suddenly became active and 53 bursts (fluence ≥0.04 Jy ms) occurred within only 40 min. We find no strict periodicity in the burst arrival times, nor any evidence for periodicity in the source’s activity between observations. The burst storm shows a steep energy distribution (power-law index α = 2.39 ± 0.12) and a bimodal wait-time distribution, with log-normal means of 0.94$^{+0.07}_{-0.06}$ s and 23.61$^{+3.06}_{-2.71}$ s. We attribute these wait-time distribution peaks to a characteristic event time-scale and pseudo-Poisson burst rate, respectively. The secondary wait-time peak at ∼1 s is ∼50 × longer than the ∼24 ms time-scale seen for both FRB 20121102A and FRB 20201124A – potentially indicating a larger emission region, or slower burst propagation. FRB 20200120E shows order-of-magnitude lower burst durations and luminosities compared with FRB 20121102A and FRB 20201124A. Lastly, in contrast to FRB 20121102A, which has observed dispersion measure (DM) variations of ΔDM > 1 pc cm−3 on month-to-year time-scales, we determine that FRB 20200120E’s DM has remained stable (ΔDM < 0.15 pc cm−3) over >10 months. Overall, the observational characteristics of FRB 20200120E deviate quantitatively from other active repeaters, but it is unclear whether it is qualitatively a different type of source.
The cellular origin of lung adenocarcinoma remains a focus of intense research efforts. The marked cellular heterogeneity and plasticity of the lungs, as well as the vast variety of molecular ...subtypes of lung adenocarcinomas perplex the field and account for the extensive variability of experimental results. While most experts would agree on the cellular origins of other types of thoracic tumours, great controversy exists on the tumour-initiating cells of lung adenocarcinoma, since this histologic subtype of lung cancer arises in the distal pulmonary regions where airways and alveoli converge, occurs in smokers as well as nonsmokers, is likely caused by various environmental agents, and is marked by vast molecular and pathologic heterogeneity. Alveolar type II, club, and their variant cells have all been implicated in lung adenocarcinoma progeny and the lineage hierarchies in the distal lung remain disputed. Here we review the relevant literature in this rapidly expanding field, including results from mouse models and human studies. In addition, we present a case for club cells as cells of origin of lung adenocarcinomas that arise in smokers.
ABSTRACT
We report four new pulsars discovered in the core-collapsed globular cluster (GC) NGC 6624 by the TRAPUM Large Survey Project with the MeerKAT telescope. All of the new pulsars found are ...isolated. PSR J1823−3021I and PSR J1823−3021K are millisecond pulsars with period of respectively 4.319 and 2.768 ms. PSR J1823−3021J is mildly recycled with a period of 20.899 ms, and PSR J1823−3022 is a long period pulsar with a period of 2.497 s. The pulsars J1823−3021I, J1823−3021J, and J1823−3021K have position and dispersion measure (DM) compatible with being members of the GC and are therefore associated with NGC 6624. Pulsar J1823−3022 is the only pulsar bright enough to be re-detected in archival observations of the cluster. This allowed the determination of a timing solution that spans over two decades. It is not possible at the moment to claim the association of pulsar J1823−3022 with the GC given the long period and large offset in position (∼3 arcmin) and DM (with a fractional difference of 11 percent compared the average of the pulsars in NGC 6624). The discoveries made use of the beamforming capability of the TRAPUM backend to generate multiple beams in the same field of view which allows sensitive searches to be performed over a few half-light radii from the cluster centre and can simultaneously localize the discoveries. The discoveries reflect the properties expected for pulsars in core-collapsed GCs.
ABSTRACT We present the description and initial results of the TRAPUM (TRAnsients And PUlsars with MeerKAT) search for pulsars associated with supernova remnants (SNRs), pulsar wind nebulae, and ...unidentified TeV emission. The list of sources to be targeted includes a large number of well-known candidate pulsar locations but also new candidate SNRs identified using a range of criteria. Using the 64-dish MeerKAT radio telescope, we use an interferometric beamforming technique to tile the potential pulsar locations with coherent beams which we search for radio pulsations, above a signal-to-noise of 9, down to an average flux density upper limit of 30 μJy. This limit is target-dependent due to the contribution of the sky and nebula to the system temperature. Coherent beams are arranged to overlap at their 50 per cent power radius, so the sensitivity to pulsars is not degraded by more than this amount, though realistically averages around 65 per cent if every location in the beam is considered. We report the discovery of two new pulsars; PSR J1831−0941 is an adolescent pulsar likely to be the plerionic engine of the candidate PWN G20.0+0.0, and PSR J1818−1502 appears to be an old and faint pulsar that we serendipitously discovered near the centre of a SNR already hosting a compact central object. The survey holds importance for better understanding of neutron star birth rates and the energetics of young pulsars.
ABSTRACT
The TRAPUM collaboration has used the MeerKAT telescope to conduct a search for pulsed radio emission from the young Small Magellanic Cloud pulsar J0058−7218 located in the supernova remnant ...IKT 16, following its discovery in X-rays with XMM–Newton. We report no significant detection of dispersed, pulsed radio emission from this source in three 2-h L-band observations using the core dishes of MeerKAT, setting an upper limit of 7.0 $\mu$Jy on its mean flux density at 1284 MHz. This is nearly seven times deeper than previous radio searches for this pulsar in Parkes L-band observations. This suggests that the radio emission of PSR J0058−7218 is not beamed towards Earth or that PSR J0058−7218 is similar to a handful of Pulsar Wind Nebulae systems that have a very low radio efficiency, such as PSR B0540−6919, the Large Magellanic Cloud Crab pulsar analogue. We have also searched for bright, dispersed, single radio pulses and found no candidates above a fluence of 93 mJy ms at 1284 MHz.
This study is a systematic review.
Propose an evidence-based algorithm for prevention, diagnosis, and management of postoperative delirium in geriatric patients undergoing elective spine surgery.
...Delirium is associated with longer stays after elective surgery, increased risk of readmission, and $6.9 billion annually in medical costs. Early diagnosis and treatment of delirium can reduce length of stay (LOS), in-hospital morbidity, and health care costs. After spinal surgery, postoperative delirium increases average LOS to >7 days and is diagnosed in 12.5%-24.3% of geriatric patients. Currently, studies for management of postoperative delirium after elective spinal procedures are not available.
A literature review was performed for observational studies, randomized controlled trials, and systematic reviews between 1990 and 2015.
Risk factors for delirium after elective spinal surgery include age, functional impairment, preexisting dementia, general anesthesia, surgical duration >3 hours, intraoperative hypercapnia and hypotension, greater blood loss, low hematocrit and albumin, preoperative affective dysfunction, and postoperative sleep disorders. Postoperatively, decreasing the use of methylprednisolone and promoting movement with an appropriate orthosis can reduce delirium incidence (P=0.0091). Polypharmacy is an independent risk factor for delirium (P=0.01) and decreasing use of delirium-inducing medications may reduce incidence. The delirium observation screening scale diagnoses and monitors delirium and is rated by nurses as easier to use than the NEECHAM Confusion Scale (P<0.003). Haloperidol is used widely to treat postoperative delirium. Randomized controlled trials show that adding quetiapine results in delirium resolution an average of 3.5 days faster than haloperidol alone (P=0.001) and decreases agitation and LOS (P=0.02; P=0.05).
An evidence-based algorithm is proposed to prevent, diagnose, and manage postoperative delirium that can be used clinically for geriatric patients undergoing elective spine surgery. Prevention and diagnosis involve efforts from the anesthesiologist and postoperative clinical care team. Treatment may include a therapeutic regimen of low-dose neuroleptic medications as needed.
Level II.
ABSTRACT
More than 100 millisecond pulsars (MSPs) have been discovered in radio observations of gamma-ray sources detected by the Fermi Large Area Telescope (LAT), but hundreds of pulsar-like sources ...remain unidentified. Here, we present the first results from the targeted survey of Fermi-LAT sources being performed by the Transients and Pulsars with MeerKAT (TRAPUM) Large Survey Project. We observed 79 sources identified as possible gamma-ray pulsar candidates by a Random Forest classification of unassociated sources from the 4FGL catalogue. Each source was observed for 10 min on two separate epochs using MeerKAT’s L-band receiver (856–1712 MHz), with typical pulsed flux density sensitivities of $\sim 100\, \mu$Jy. Nine new MSPs were discovered, eight of which are in binary systems, including two eclipsing redbacks and one system, PSR J1526−2744, that appears to have a white dwarf companion in an unusually compact 5 h orbit. We obtained phase-connected timing solutions for two of these MSPs, enabling the detection of gamma-ray pulsations in the Fermi-LAT data. A follow-up search for continuous gravitational waves from PSR J1526−2744 in Advanced LIGO data using the resulting Fermi-LAT timing ephemeris yielded no detection, but sets an upper limit on the neutron star ellipticity of 2.45 × 10−8. We also detected X-ray emission from the redback PSR J1803−6707 in data from the first eROSITA all-sky survey, likely due to emission from an intrabinary shock.
Current orthopaedic clinical methods do not provide an objective measure of fracture healing or weight bearing for lower extremity fractures. The following report describes a novel approach involving ...in-situ strain sensors to objectively measure fracture healing. The sensor uses a cantilevered indicator pin that responds to plate bending and an internal scale to demonstrate changes in the pin position on plain film radiographs. The long lever arm amplifies pin movement compared to interfragmentary motion, and the scale enables more accurate measurement of position changes. Testing with a human cadaver comminuted metaphyseal tibia fracture specimen demonstrated over 2.25 mm of reproducible sensor displacement on radiographs with as little as 100 N of axial compressive loading. Finite element simulations determined that pin displacement decreases as the fracture callus stiffens and that pin motion is linearly related to the strain in the callus. These results indicate that an implanted strain sensor is an effective tool to help assess bone healing after internal fixation and could provide an objective clinical measure for return to weight bearing.
Abstract Background Hepatitis B surface antigen (HBsAg) clearance during chronic hepatitis B (CHB) infection is associated with improved long-term clinical outcome, so is considered an important ...therapeutic goal in CHB. Studies have shown that serum HBsAg quantification during, and at end of, treatment may predict long-term HBsAg loss. Objectives Performance comparison of the qualitative Elecsys HBsAg II assay using a quantitative research protocol and an established quantitative HBsAg assay. Study design A dilution algorithm was developed for the Elecsys HBsAg II assay to allow quantification of HBsAg levels; this was used to measure HBsAg levels in a range of samples including sera from patients infected with different HBV genotypes, HBV mutants, and longitudinal samples from patients undergoing antiviral treatment. Results were compared with those from the quantitative Architect HBsAg assay. Results There was significant overall correlation between Elecsys and Architect assays (correlation coefficient r = 0.97; p < 0.001). HBsAg levels measured with both assays correlated well in all phases of infection ( r = 0.80–0.96), across all genotypes tested (HBV genotype A, r = 0.89; HBV genotype D, r = 0.97), and in samples with lamivudine-resistant mutations ( r = 0.94). Bland–Altman analysis showed only minor discordance between assays in different phases of chronic HBV-infection (3.8–5.1%). This strong correlation was also present for sera with lower HBsAg concentrations. On-treatment HBsAg levels were similar when measured with either assay. Conclusions Using a simple dilution algorithm, the quantitative Elecsys HBsAg II assay reliably determined serum HBsAg levels in a wide range of samples, and showed very high correlation with the Architect HBsAg assay.
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