Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study.

OBJECTIVE: To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). METHODS: Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. RESULTS: A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05). CONCLUSIONS: For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.

Psoas major and lumbar lordosis may correlate with pain episodes during Sorensen test in patients with non-specific low back pain.

BACKGROUND: The reason that participants develop pain episodes during the Sorensen test remains unclear. Lumbar lordosis and trunk muscle are important for dynamic stability of the spine; however, their role in pain episodes during the Sorensen test has not yet been discussed. OBJECTIVE: To investigate the effects of muscular morphology and lumbar curvature on pain development during the Sorensen test in patients with non-specific low back pain (LBP). METHODS: Ninety-one patients diagnosed with chronic non-specific LBP and underwent the Sorensen test were enrolled. Lumbar lordosis, cross-sectional area and fat infiltration rate of trunk muscle and centroid line of psoas major (dividing into three types: anterior arc, linear and posterior arc) were measured using ImageJ software. All recruited patients were grouped into pain episode and exhaustion groups and were matched for the confounders based on propensity scores. The above parameters were compared between groups and further adjusted for confounding bias. RESULTS: After adjustment , the mean differences in lumbar lordosis of 12.1 ± 2.3∘ between the two groups in the complete cohort and of 13.9 ± 2.5∘ in the matching cohort remained significant, the exhaustion group had a 0.22-fold and 0.08-fold risk of presenting as linear and posterior arc types, respectively, compared with the pain episode group in the complete cohort (p= 0.008, p= 0.004), the corresponding values were 0.19-fold and 0.05-fold, respectively, in the matching cohort (p= 0.014, p= 0.010). Logistic regression demonstrated that lumbar lordosis, the linear and posterior arc types were significantly associated with pain episode during the test (OR = 0.78, p< 0.001; OR = 4.50, p= 0.038; OR = 9.93, p= 0.033). CONCLUSIONS: Lower lumbar lordosis and linear and posterior arc types of the psoas major centroid line were possibly relevant to the pain episode during Sorensen test in patients with chronic non-specific LBP.

Characteristics of falls among older hip fracture patients from six Chinese hospitals: a post-hoc descriptive analysis.

BACKGROUND: There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. METHODS: This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. RESULTS: A total of 1,892 patients' fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01-18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). CONCLUSIONS: Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic.

The effectiveness of a co-management care model on older hip fracture patients in China - A multicentre non-randomised controlled study.

BACKGROUND: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients' outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. METHODS: This non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality. FINDINGS: There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01). INTERPRETATION: Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence. FUNDING: The study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071).

Uncovering a Key Role of ETS1 on Vascular Abnormality in Glioblastoma.

Glioblastoma (GBM) is the most aggressive type of brain tumor. Microvascular proliferation and abnormal vasculature are the hallmarks of the GBM, aggravating disease progression and increasing patient morbidity. Here, we uncovered a key role of ETS1 on vascular abnormality in glioblastoma. ETS1 was upregulated in endothelial cells from human tumors compared to endothelial cells from paired control brain tissue. Knockdown of Ets1 in mouse brain endothelial cells inhibited cell migration and proliferation, and suppressed expression of genes associated with vascular abnormality in GBM. ETS1 upregulation in tumor ECs was dependent on TGFß signaling, and targeting TGFß signaling by inhibitor decreased tumor angiogenesis and vascular abnormality in CT-2A glioma model. Our results identified ETS1 as a key factor regulating tumor angiogenesis, and suggested that TGFß inhibition may suppress the vascular abnormality driven by ETS1.

Hydraulic Integrated Interconnected Regenerative Suspension: Modeling and Characteristics Analysis.

A novel suspension system, the hydraulic integrated interconnected regenerative suspension (HIIRS), has been proposed recently. This paper demonstrates the vibration and energy harvesting characteristics of the HIIRS. The HIIRS model is established as a set of coupled, frequency-dependent equations with the hydraulic impedance method. The mechanical-fluid boundary condition in the double-acting cylinders is modelled as an external force on the mechanical system and a moving boundary on the fluid system. By integrating the HIIRS into a half car model, its free and forced vibration analyses are conducted and compared with an equivalent traditional off-road vehicle. Results show that the natural frequency and the damping ratio of the HIIRS-equipped vehicle are within a proper range of a normal off-road vehicle. The root mean square values of the bounce and roll acceleration of the HIIRS system are, respectively, 64.62 and 11.21% lower than that of a traditional suspension. The average energy harvesting power are 186.93, 417.40 and 655.90 W at the speeds of 36, 72 and 108 km/h for an off-road vehicle on a Class-C road. The results indicate that the HIIRS system can significantly enhance the vehicle dynamics and harvest the vibration energy simultaneously.

Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery.

BACKGROUND: To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery. METHODS: The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patients were excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated using Nadler's formula and Gross' formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05. RESULTS: There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler's formula and Gross' formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction. CONCLUSIONS: Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.

Ezrin/NF-κB Pathway Regulates EGF-induced Epithelial-Mesenchymal Transition (EMT), Metastasis, and Progression of Osteosarcoma.

BACKGROUND Epithelial-mesenchymal transition (EMT) is responsible for metastasis of cancers, and NF-κB can promote tumor progression. Ezrin is an important molecule participating in EMT. However, whether Ezrin mediates NF-κB in EGF-induced osteosarcoma is unknown. MATERIAL AND METHODS Ezrin phosphorylation, NF-κB activation, and EGF-induced EMT were studied in MG63 and U20S cells with NF-κB inhibition, silencing, or over-expressing Ezrin. Cell morphology, proliferation, migration, and motility were analyzed. An osteosarcoma model was established in mice by injecting MG63 and U20S and reducing Ezrin. RESULTS With EGF induction in vitro, Ezrin Tyr353 and Thr567 were phosphorylated, and EMT, proliferation, migration, and motility of osteosarcoma cells were promoted. Silencing Ezrin suppressed and over-expressing Ezrin promoted the nuclear translocation of p65 and phosphorylated IκBα (p-IκBα) in EGF-induced osteosarcoma cells. NF-κB inhibitor blocked EGF-induced EMT in both cell types, as well as reserving cell morphology and suppressing proliferation, migration, and motility. In vivo, reducing Ezrin significantly suppressed metastasis of osteosarcoma xenografts, increased liver and lung weights, and activated NF-κB, which were both induced by EGF. CONCLUSIONS Ezrin/NF-κB regulated EGF-induced EMT, as well as progression and metastasis of osteosarcoma in vivo and in vitro. Ezrin/NF-κB may be a new therapeutic target to prevent osteosarcoma from deterioration.

Optimization and analysis of centrifugal pump considering fluid-structure interaction.

This paper presents the optimization of vibrations of centrifugal pump considering fluid-structure interaction (FSI). A set of centrifugal pumps with various blade shapes were studied using FSI method, in order to investigate the transient vibration performance. The Kriging model, based on the results of the FSI simulations, was established to approximate the relationship between the geometrical parameters of pump impeller and the root mean square (RMS) values of the displacement response at the pump bearing block. Hence, multi-island genetic algorithm (MIGA) has been implemented to minimize the RMS value of the impeller displacement. A prototype of centrifugal pump has been manufactured and an experimental validation of the optimization results has been carried out. The comparison among results of Kriging surrogate model, FSI simulation, and experimental test showed a good consistency of the three approaches. Finally, the transient mechanical behavior of pump impeller has been investigated using FSI method based on the optimized geometry parameters of pump impeller.

External fixation in early treatment of unstable pelvic fractures.

BACKGROUND: Patients with pelvic fractures are often treated in hospitals without the capacity to implement an open reduction internal fixation (ORIF). This often leads to pelvic malunion in patients with unstable pelvic fracture, shock or even death due to uncontrollable pelvic hemorrhage and unstable hemodynamics. This study explored the role of early external fixation (within 7 days) for patients with unstable pelvic fractures. METHODS: A retrospective analysis was conducted on 32 patients with unstable pelvic fractures treated with early external fixation from January 2005 to January 2010 (Tile type B: 18 cases; C: 14 cases). The study comprised 28 males and 4 females, with a mean age of (32 ± 8) years (range, 21-56 years). Of these patients, 22 were treated with emergency pelvic external fixation and 10 were treated with external fixation within 1-7 days. Fifteen cases suffered traumatic hemorrhagic shock. A statistical analysis was conducted to compare fluid infusion and blood transfusion volumes within the first 24 hours of these shock patients with another cohort of patients treated without early external fixation from January 1993 to January 1998. RESULTS: The average follow-up was (34.7 ± 14.6) months (range, 6-66 months). Six to eight weeks after external fixation, patients could walk with crutches; by 12 weeks, external fixation was removed and all fractures had healed. Seven patients presented with sequelae, including 3 patients with long-term lumbosacral pain, 3 patients with erectile dysfunction and 1 patient with Morel-Lavallee lesion and other complications. The 15 shock patients in this study (2005-2010 group) required significantly lower volumes of fluid infusion and blood transfusion (P(fluid) = 0.000; P(transfusion) = 0.000) as compared to the 1993-1998 cohort. CONCLUSIONS: The early application of external fixation in unstable pelvic fracture patients positively affects hemodynamic stability, with outstanding efficacy as a final fixation option for unstable pelvic fractures.