Ecdysone exerts biphasic control of regenerative signaling, coordinating the completion of regeneration with developmental progression.

In Drosophila melanogaster, loss of regenerative capacity in wing imaginal discs coincides with an increase in systemic levels of the steroid hormone ecdysone, a key coordinator of their developmental progression. Regenerating discs release the relaxin hormone Dilp8 (Drosophila insulin-like peptide 8) to limit ecdysone synthesis and extend the regenerative period. Here, we describe how regenerating tissues produce a biphasic response to ecdysone levels: lower concentrations of ecdysone promote local and systemic regenerative signaling, whereas higher concentrations suppress regeneration through the expression of broad splice isoforms. Ecdysone also promotes the expression of wingless during both regeneration and normal development through a distinct regulatory pathway. This dual role for ecdysone explains how regeneration can still be completed successfully in dilp8- mutant larvae: higher ecdysone levels increase the regenerative activity of tissues, allowing regeneration to reach completion in a shorter time. From these observations, we propose that ecdysone hormone signaling functions to coordinate regeneration with developmental progression.

Hip Alpha Angle is Associated with Anterior-Superior Labral Tears but not Anterior Labral Tears.

INTRODUCTION: The purpose of this study is to examine the associations between hip and acetabular morphology, clinical and demographic patient factors, and acetabular labral tear location in young adults. MATERIALS AND METHODS: This study was reviewed by the local Institutional Review Board. The hip magnetic resonance imaging arthrograms from 100 young adult patients (aged 18-35 years) who underwent hip arthroscopy within 1 month of the arthrogram were reviewed. Clinical and demographic variables including age, height, weight, body mass index (BMI) and quantitative hip measurements of acetabular anteversion, alpha and beta angles, femoral head extrusion index, lateral center edge angle, acetabular depth-width ratio, Sharp's and Tönnis' angles were measured, and compared based on acetabular tear location. RESULTS: Ninety-six (96%) of patients had arthroscopically confirmed acetabular tears, and 4 (4%) patients had a normal acetabula labrum. Most (85 [88.5%]) patients had tears involving the anterior-superior labrum and another location, 41 (42.7%) patients had tears involving the anterior labrum and another location, and 35 (36.5%) had tears involving the superior-lateral labrum and another location. Tears commonly occurred in more than one location, with 37 (38.5%) patients having tears in both the anterior and anterior-superior labrum; 28 (29.2%) patients with tears in both the anterior-superior and superior-lateral labrum and 11 (11.5%) patients with tears in the anterior and superior-lateral labrum. Patients with isolated tears of the anterior-superior labrum had on average higher alpha angles than patients with isolated tears of the anterior labrum (P = 0.007). In patients with anterior-superior labral tears, increased BMI (P = 0.033), and weight (P = 0.024) were associated with having concomitant tears of the superior-lateral labrum. DISCUSSION: MR arthrograms are 96% sensitive for detecting acetabular labral tears. Acetabular labral tears tend to co-occur in different locations, with anterior and anterior-superior labral tears most commonly co-occurring. Patients with isolated anterior-superior labral tears had on average higher alpha angles than patients with isolated anterior labral tears.

Randomized Controlled Trials for Geriatric Hip Fracture Are Rare and Underpowered: A Systematic Review and a Call for Greater Collaboration.

BACKGROUND: Geriatric hip fracture is a common condition, and there are many open questions regarding patient management. Among the various types of medical evidence, the prospective randomized controlled trial (RCT) is considered the best. Our primary hypothesis was that small sample size would be seen frequently among RCTs involving geriatric patients with hip fracture. A related hypothesis was that studies from the United States would have particularly large deficits in sample size. Therefore, we asked the following research questions: (1) What is the mean sample size of RCTs involving geriatric patients with hip fracture? (2) How do sample sizes for studies from the U.S. differ from those performed elsewhere? METHODS: Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, a systematic review of hip fracture RCTs was conducted. The Embase and MEDLINE databases were searched. Additional data included the country of origin, the power of the study, and whether sample size calculations were performed. One hundred and forty-seven RCTs were identified. RESULTS: The mean sample size of the 147 RCTs was 134.9. The mean sample size for the 7 American trials was 110.3, and the mean sample size for all trials conducted outside of the United States was 136.1. A sample size that was sufficient to ensure 80% power was used in only 31.3% of the RCTs. CONCLUSIONS: RCTs for hip fracture are small and underpowered. Moreover, <5% of the RCT studies have been conducted in the U.S., and they were smaller than those conducted elsewhere. The shortage of American trials may be a feature of the dispersion of geriatric hip fracture care across many hospitals in the United States. If so, better clinical research might require more centralized care (e.g., in specialized geriatric hip fracture centers) or greater collaboration among the many hospitals that provide care.

The New APGAR SCORE: A Checklist to Enhance Quality of Life in Geriatric Patients with Hip Fracture.

For geriatric patients with hip fractures, the broken bone is the reason for admission, but only part of the overall disease. Indeed, it may be more helpful to consider the patient having geriatric hip fracture syndrome or sustaining a hip attack, as there are many associated medical, social, psychological, and other problems to which attention must be paid. To that end, we have identified a series of 10 steps, collected into a checklist, that can be undertaken for all patients with geriatric hip fracture. In homage to the maxim "we come into the world under the brim of the pelvis and go out through the neck of the femur," we defined our checklist by the acronym APGAR SCORE, named after the classic checklist of the same name used to assess a newborn child. The 10 elements include attending to problems of Alimentation and nutrition, Polypharmacy, and Gait; initiating a discussion about Advance care planning; correcting any Reversible cognitive impairment; maximizing Social support; checking for and remediating Cataracts or other impairments of vision; assessing for and addressing Osteoporosis; and last, ensuring that Referrals are made and that the patient has a safe Environment after discharge. For the newborn, the Apgar score has been criticized as an imperfect tool, and likewise the problem of geriatric hip fracture will not be solved with this new Apgar score either. Nonetheless, a score of 10 here,1 point for each item, may help to optimize the outcome for this difficult disease.