Introduction:
Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved ...the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality.
Patients and Methods:
Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests.
Results:
Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (≥85 years old, P = .032), existing comorbidity (P = .002), preinjury mobility level (P = .026), mental state (Mini-Mental State Examination > 23, P = .040), low preoperative plasma albumin level (P = .007), and high preoperative blood C-reactive protein level (CRP; P = .012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury.
Discussion:
As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation.
Conclusion:
The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate.
Anxiety disorders constitute a spectrum of psychological conditions affecting millions of individuals worldwide, imposing a significant health burden. Historically, the development of anxiolytic ...medications has been largely focused on neurotransmitter function and modulation. However, in recent years, neurolipids emerged as a prime target for understanding psychiatric pathogenesis and developing novel medications. Neurolipids influence various neural activities such as neurotransmission and cellular functioning, as well as maintaining cell membrane integrity. Therefore, this review aims to elucidate the alterations in neurolipids associated with an anxious mental state and explore their potential as targets of novel anxiolytic medications. Existing evidence tentatively associates dysregulated neurolipid levels with the etiopathology of anxiety disorders. Notably, preclinical investigations suggest that several neurolipids, including endocannabinoids and polyunsaturated fatty acids, may hold promise as potential pharmacological targets. Overall, the current literature tentatively suggests the involvement of lipids in the pathogenesis of anxiety disorders, hinting at potential prospects for future pharmacological interventions.
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•Neurolipids appear to be implicated in the pathogenesis of anxiety disorders•Sphingolipids and lipid peroxidation markers are potential biomarkers for anxiety disorders•MAGL and FAAH inhibitors appear to be promising for reducing anxiety-related behaviour•Evidence for PUFA as an anxiolytic agent is inconclusive•Research in biochemical, neurophysiological, and clinical studies is needed to clarify neurolipids' role in anxiety
In the dual fluidised bed steam gasification process a product gas with a relatively high calorific value is produced. For clean biomass such as wood pellets or wood chips this process has been ...previously demonstrated in pilot-scale. Within this work, the applicability of waste biomass such as sewage sludge or manure as a fuel for this gasification process was investigated experimentally. A special focus was given to the concentration of impurities in the product gas of the gasifier (such as tar, NH3, H2S and Cl). The gasification experiments have shown, that the steam gasification of both biogenic waste materials is possible. For all fuels a high gas yield, close to the gas yield of wood pellets, was achieved and the product gas composition did not vary much between the fuels. Due to the different structures of the fuels and their different nitrogen, sulphur and chlorine contents, the concentrations of the impurities such as tar, NH3 H2S and Cl can vary significantly: tar concentrations of up to 100 g ⋅ m−3, NH3 concentrations of up to 0.06 m3 m−3 and H2S concentrations of up to 7000 ⋅ 10−6⋅m3⋅m−3 were measured.
•The use of waste biomass such as sewage sludge and manure as fuel for the dual fluidised bed steam gasification process was successfully demonstrated in lab-scale.•The use of these low-cost fuels can decrease the operating costs considerably. Fur-thermore it enables new applications, such as disposal applications.•Experiments at a dual fluidised bed reactor system with a thermal fuel input of 20 kW have shown that the use of these fuels is possible:For all fuels no bed agglomerations up to a gasification temperature of 820 °C and up to a combustion temperature of 950 °C were detected.The product gas yield of the different fuels was only 10 to 20 % lower than the product gas yield of similar experiments performed with wood pellets.The product gas composition of the main components (H2, CO, CH4, C2-C4, CO2) did not vary much between the different fuels.Challenging can be the higher concentration of impurities (tar, NH3, H2S and Cl) in the product gas of the gasifier.•The experiments have shown that the addition of limestone can reduce the concen-trations of impurities such as tar, NH3, H2S considerablyTar concentration were reduced by about 80 %,H2S concentration were reduced by about 30 %.NH3 concentration were reduced by about 50 %.
Osteoporosis increases the risk of periprosthetic fracture and loosening in hip arthroplasty. Many methods have been proposed to assess bone quality in X-rays, including both qualitative such as the ...Dorr classification and quantitative such as the Calcar-Canal Ratio (CCR) and Cortical-Thickness index/Canal-Bone ratio (CTI/CBR). The Canal-Diaphysis ratio (CDR) has been described as a predictor for hip fragility fractures; however, its relationship with bone mineral density (BMD) has not been described. The purpose of this study was to evaluate the correlation of the Dorr classification, CCR, CTI/CBR, and CDR with BMD of the proximal femur in patients without hip fracture.
Forty-seven patients over 45 years of age who had less than 6 months between radiographs and dual-energy X-ray absorptiometry were evaluated. Measurements of CCR, CBR, CDR, and Dorr classification were performed in all radiographs by 2 independent observers.
The CDR had a high correlation (r = 0.74, P=<0.01) with BMD, whereas the CTI/CBR had a moderate correlation (r = 0.49, P=<0.01), and the CCR had no correlation with BMD (r = 0.06, P = .96). When evaluating the receiver operating characteristic curve, CDR showed the best performance (area under curve AUC = 0.75) followed by CBR (AUC = 0.73) and CCR (AUC = 0.61). The optimal cutoff value for the CDR was 0.49, with 100% sensitivity and 58% specificity. The inter- and intra-observer variability was good for all methods. No differences were found between Dorr classification of patients who had or did not have osteoporosis.
Of all the analyzed methods, the CDR was found to have the best correlation with BMD. This study proposes the use of CDR as a tool for assessing bone quality when deciding the implant fixation method in hip arthroplasty.
hip fracture represents a global health problem, with a high morbidity and mortality rate and an increasing incidence. The treatment of trochanteric fractures is reduction and osteosynthesis, and ...implant selection depends mainly on the stability of the fracture and lateral wall competence. Lateral wall competence has gained relevance in recent years, which led to the modification of the AO/OTA classification. However, determination of lateral wall integrity is difficult from plain radiographs; the influence of images with traction on its measurement has not been evaluated.
prospective concordance study, emergency and post-traction radiographs of 65 patients with trochanteric fracture were evaluated by six orthopedic surgeons independently, measuring the lateral wall, classifying the fracture according to the AO/OTA 2018 classification and selecting the implant for osteosynthesis. A comparison of incompetent to intact lateral wall proportion between each image set was made. Secondary outcomes were the inter-observer correlation of lateral wall measurement and inter-observer agreement of classification and implant choice.
the proportion of patients with an incompetent lateral wall in emergency x-ray was 37.43% (CI 95% 0.326-0.422), while the proportion in post-traction fluoroscopy was 15% (CI 95% 0.115-0.185), with a statistically significant difference (p < 0.001). 40.1% of patients with an incompetent lateral wall changed to an intact one. Inter-observer correlation for the lateral wall thickness was 0.399 (CI 95% 0.292-0.519) in emergency x-ray and 0.658 (CI 95% 0.564-0.748) in post-traction fluoroscopy, with a substantial agreement. Inter-observer agreement for the fracture classification was fair to moderate using emergency x-ray (κ 0.369 95%CI 0.330-0.408) and fair to moderate with post-traction fluoroscopy (κ 0.400, 95% CI 0.334-0.466).
traction images significantly change the measurement of the lateral wall in trochanteric fractures, changing from an incompetent to a competent wall in 40% of patients. The correct classification of trochanteric fractures is crucial to make the best decision when deciding which implant to use, and the measurement of the lateral wall is determinant in the actual AO/OTA classification. Therefore, traction images appear as necessary for correct decision-making.
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