Excess Mortality for Femoral Intertrochanteric Fracture Patients Aged 50 Years and Older Treated Surgically and Conservatively in Tianjin, China: A Cohort Study.

OBJECTIVE: Intertrochanteric fracture is one type of hip fracture, which is the most serious consequence of osteoporosis. Along with the growing elderly population, intertrochanteric fracture is expected to rise increasingly. The aim of this study was to assess excess mortality after intertrochanteric fractures and to identify the predictors of long-term mortality by therapy among patients aged 50 years and older in Tianjin. METHODS: This is a retrospective cohort study on mortality for 3029 patients aged 50 years and older in Tianjin experiencing an intertrochanteric fracture between December 26, 2014 and December 31, 2018. Data were from Tianjin Hospital Hip Fracture (THHF) cohort. Follow-up period was until March 31, 2022. Mortality, excess mortality, and comorbidities were analyzed and stratified by therapy and gender. Time dependent Cox models were performed to estimate the effects of the variables. RESULTS: Absolute mortality for all the patients was 5.90% at 3 months, 12.55% at 12 months, 19.92% at 24 months and 27.28% at 36 months. Absolute mortality for surgical group was 1.57% at 3 months, 4.77% at 12 months, 8.49% at 24 months and 12.07% at 36 months, significantly lower than conservative group: 10.50% at 3 months, 20.73% at 12 months, 31.96% at 24 months and 43.04% at 36 months. We found a substantially lower mortality (hazard ratio [HR] 0.34, 95% confidence internal, [CI]: 0.23-0.52, p = 0.000) among patients undergoing surgical therapy than those undergoing conservative therapy, even when controlled for gender, age, the length of hospital stay, and all the comorbidities. Female patients (HR 0.68, 95% CI: 0.58-0.79, p = 0.000) were less likely to die than male patients after an intertrochanteric fracture. Patients treated by the two methods were both found to have excess mortality rates compared to the general population, although in different levels. The excess mortality rates for patients in the conservative therapy group were 14.46% in males and 17.93% in females, while in the surgical therapy group, 2.78% in females and 4.37% in males. The comorbidities moderate or severe renal disease (HR 2.19, 95% CI: 1.61-2.98, p = 0.000), metastatic solid tumor (HR 6.35, 95% CI: 1.56-25.85, p = 0.010), hypoproteinemia (HR 1.22, 95% CI: 1.01-1.47, p = 0.034), and older age (HR 1.89, 95% CI: 1.73-2.08, p = 0.000) were also risk factors on mortality. A worse-case analysis for the primary outcome were performed as sensitivity analysis and it was consistent with the original conclusion. CONCLUSION: Intertrochanteric factures for people aged 50 years older were found to have excess mortality compared to the general population in Tianjin city, and preventing the fractures in the hip for elderly people was imperative. After controlling tfor comorbidities and age, female gender and surgical therapy were protective factors for the death after fractures, which could provide strong evidence for patients and surgeons to make decisions.

Two new species of Sabacon Simon, 1879 (Opiliones: Dyspnoi: Sabaconidae) from Yunnan Province, China.

Two new species of the harvestman genus Sabacon Simon, 1879 are recorded from Yunnan Province, southern China, Sabacon monacanthus sp. n. (male and female; relationships unclear) and S. suzukii sp. n. (male and female; closely related to S. kangding Martens, 2015 from Sichuan Province, southwestern China).

[Evaluation of the myocardial protection of trimetazidine during percutaneous coronary intervention: a multi-center randomized and controlled clinical study].

OBJECTIVE: To evaluate the myocardial protection effects of trimetazidine during percutaneous coronary intervention (PCI). METHODS: 101 patients from 5 hospitals with stable or unstable angina pectoris were enrolled in this study. All the patients were randomized into two groups: a trimetazidine group (n=54) and a control group (n=47). The trimetazidine group received oral trimetazidine 20 mg three times a day for (5±2) days before coronary angiography and a loading dose of 60 mg 30 minutes before PCI. The daily routine dosage was continued for 4 weeks after the procedure. The control group received similar treatment except trimetazidine. For each patient, the angina pectoris attacks, CK-MB, electrocardiogram and echocardiogram were noted. RESULTS: Angina did not occur in trimetazidine group during the procedure but occurred in 12 patients (25.5%) in the control group (P<0.001). The changes of ST-segment and T wave during balloon dilatation in PCI procedure were less in the trimetazidine group (60.8% vs 78.3%, P<0.05). Ejection fraction in the trimetazidine group was higher than that in the control group 4 weeks [(66.6±7.1)% vs (63.0±7.7)%, P=0.03] after PCI. CONCLUSION: Trimetazidine could reduce the frequency of angina pectoris attacks and myocardial damage during PCI. It also improves left ventricular function during follow-up after PCI.