Mortality following combined fractures of the hip and proximal humerus

BACKGROUND Hip fractures and proximal humerus fractures are known to be associated with increased mortality, but the impact on mortality of combining these two common injuries is not well known.AIM To compare mortality, inpatient stay and discharge destination for patients with combined hip and proximal humerus fractures with those sustaining isolated hip fractures.METHODS Using the United Kingdom national hip fracture database, we identified all hip fracture patients over the age of 60 admitted to a single trauma unit from 2010-2016. Patients sustaining a proximal humerus fracture in addition to their hip fracture were identified using hospital coding data. We calculated the 30-d and one-year mortality for both the hip fracture cohort and the combined hip and proximal humerus fracture cohort. Other variables recorded included age, gender and whether the proximal humerus was treated with or without an operation.RESULTS We identified 4131 patients with hip fractures within the study period and out of those 40 had sustained both a hip and a proximal humerus fracture. Mean age in the hip fracture cohort was 80.9 years and in the combined fracture group 80.3 years. Out of the 40 patients in the combined group four were treated operatively. The 30-d mortality for our hip fracture cohort was 7.2% compared to the mortality of our combined cohort of 12.5%(P = 0.163). The one-year mortality for our hip fracture cohort was 26.4% compared to 40% for the combined fracture cohort(P = 0.038). We also found patients with combined injuries were less likely to return to their own home.CONCLUSION The 30-d and one-year mortality is higher for those patients who have sustained a combined hip and proximal humerus fracture when compared to those with a hip fracture alone.     

Immature ovaries and polycystic kidneys in the congenital polycystic kidney mouse may be due to abnormal sex steroid metabolism

Ke 6 is a 17beta-hydroxysteroid dehydrogenase (17betaHSD) that is expressed in the kidneys and gonads. The expression of this gene is markedly reduced in three murine models of recessive polycystic kidney disease, a developmental disorder, where some nephrons within the affected kidneys develop into huge fluid-filled cysts while the non-cystic nephrons atrophies by apoptosis. Here, we show that in the cpk/cpk mouse, which have polycystic kidneys, the female reproductive organs also fail to mature properly and remain arrested at an early stage of development. Direct measurement of 17betaHSD activity showed a severe reduction in estrogen and androgen metabolism within gonadal and non-gonadal tissues of the cpk/cpk mouse. Using immunofluorescent staining we localized the expression of the Ke 6 protein within the female mouse reproductive organs. Our findings suggest that estrogen/androgen metabolism may play an important role in the development of the urogenital systems.     

Asia-Pacific consensus on the management of gastroesophageal reflux disease: update

Background and Aims: Since the publication of the Asia‐Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On‐demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non‐GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.     

The degree of hair graying as an independent risk marker for coronary artery disease,a CT coronary angiography study

Background

Cardiovascular disease is a leading cause of death worldwide. Aging is an unavoidable coronary risk factor and is associated with dermatological signs that could be a marker for increased coronary risk. We tested the hypothesis that hair graying as a visible marker of aging is associated with risk of coronary artery disease (CAD) independent of chronological age.

Evaluation of an intervention to improve successful completion of the Mini-AQLQ: comparison of postal and supervised completion.

INTRODUCTION: Previous postal administration of Mini Asthma-related Quality of Life Questionnaire (Mini-AQLQ) (validated for self-completion under supervision) resulted in 12.7% completion error rate. AIMS: To administer the Mini-AQLQ by post with instructions, and to compare completion errors with our previous study and usable response rate with supervised self-completion. METHOD: The Mini-AQLQ, with an instruction sheet, was posted to 96 participants from UK general practice, for completion 1 week before supervised self-completion in the surgery. RESULTS: 94/96 (98%) postal questionnaires were returned: the error rate of 10.6% was similar to our previous study (postal versus previous: 10/94 versus 23/181: P=0.62). 86/96 (90%) attended for supervised completion with no completion errors (supervised versus postal: 0/86 versus 10/94: P相似文献   

Acid sensors in the gut: a taste of things to come

Physiological pain is mediated by the transduction of nociceptive stimuli via the peripheral terminals of nociceptors to the spinal dorsal horn neurones, before projection to the cerebral cortex. Pathological states of inflammation and nerve injury alter the transduction properties of peripheral nociceptors and spinal dorsal horn neurones via post-translational changes induced within receptors/ion channels by activation of intracellular transduction cascades. This leads to a sensitized system with altered stimulus response characteristics, which manifests as a clinical hypersensitivity state. With the recent advances in molecular biology it has become possible to identify the various receptors and ion channels involved in nociceptive transduction in health and disease. This new insight is likely to lead to a more targeted approach towards treating both visceral and somatic pain.     

Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer

Uncontrolled trials have reported significant weight gain in women with breast cancer during treatment with adjuvant chemotherapy. We prospectively evaluated body composition before (visit 1), immediately after (visit 2), and 6 months after (visit 3) chemotherapy in 20 women with stages I-IIIA breast cancer [body mass index (BMI): 24.1 +/- 3.9 kg/m(2)]. We compared their weight change to 51 age- and BMI-matched healthy controls (BMI: 25.5 +/- 3.8 kg/m(2)). In women with breast cancer, there was no weight change from visit 1-2, or from visit 1-3, but weight increased from visit 2-3 (+1.09 +/- 2.46 kg; P = 0.05). Weight change was not different from controls during either interval. In the breast cancer group, the percentage of body fat assessed by air displacement plethysmography increased, and fat-free mass decreased from visit 1-2 (+2.3 +/- 4% and -2.2 +/- 4%; P = 0.02) and from visit 1-3 (+4.0 +/- 6% and -3.8 +/- 6%; P = 0.01). By dual energy x-ray absorptiometry, the percentage of body fat increased from visit 2-3 (+0.9 +/- 1.6%; P = 0.02). Bone mineral content decreased from visit 2-3 (-0.02 +/- 0.04 kg; P = 0.02) and from visit 1-3 (-0.04 +/- 0.06 kg; P = 0.005). By computed tomography, the visceral adipose to sc adipose tissue ratio decreased from visit 1-3 (-0.02 +/- 0.05 ml; P = 0.02). We conclude that, compared with controls, women with breast cancer receiving modern adjuvant chemotherapy regimens show no significant changes in weight during the first year of their treatment. They do, however, appear to undergo unfavorable changes in body composition.     

Recurrent multiple cardiac hydatidosis.

Cardiac hydatid cyst is an uncommon disease. We report on a woman admitted to our clinic with chest pain and palpitations. The ECG showed anterior ischemia, and coronary anatomy was normal. The diagnosis was: multiple cardiac hydatid cysts, for which she had undergone surgery 4 years earlier for a 5 x 5 hydatid cyst and treated with albendazole. Despite this, there was a recurrence of multiple cysts. Recurrence of intracavitary hydatid cyst is rare, and surgical treatment of multiple, small cysts remains controversial.     

Possible pathogenetic role of new cytokines in postmenopausal osteoporosis and changes during calcitonin plus calcium therapy

The present study was designed to test if the serum cytokines (interleukin, or IL-1beta, -2, -2r, -6, -6r, -8, and -10, and tumor necrosis factor alpha, or TNF-alpha) and osteocalcin levels were different between 50 osteoporotic and 30 postmenopausal nonosteoporotic women and to evaluate the efficacy of calcitonin therapy during 6 months on serum cytokines and osteocalcin levels in postmenopausal osteoporotic women. In our study, serum levels of osteocalcin, TNF-alpha, IL-2, and IL-8 were significantly higher in the patient group (P < 0.05), whereas serum levels of IL-10 and IL-6r were significantly lower in the patient group (P < 0.05). When analysed separately according to bone turnover, serum levels of IL-10 and IL-6r were significantly lower in the normal-turnover group (P < 0.05), and IL-2, IL-8, and TNF-alpha were significantly higher in the high-turnover group than in the control group (P < 0.05). Statistically significant improvement seemed to happen in the patients receiving calcitonin plus calcium therapy (P < 0.05) concerning levels of serum IL-6r at the 1st month (P < 0.05), IL-10, IL-2r, IL-6r, and osteocalcin at the 3rd month, and IL-6r and osteocalcin at the end of the 6th month. Our findings demonstrate that calcitonin plus calcium therapy appears to be particularly more effective for patients with high turnover. In addition, our study suggests that IL-10 and IL-6r may have an important role in normal-turnover osteoporosis, while IL-2, IL-8, and TNF-alpha may play an important role in high-turnover postmenopausal osteoporosis.