Relationship between the perioperative prognostic nutritional index and postoperative gait function in elderly hip fractures.

Objectives: We investigated the relationship between the perioperative nutritional status and postoperative walking ability in patients with hip fractures. Methods: We included 246 surgically treated elderly patients with hip fractures who were ambulatory before the injury. Patients were divided into two groups: group A, who were able to walk at discharge, and group B, who were unable to walk at discharge. We pair-matched these two groups according to age, preoperative subdivided walking ability, and fracture site to form groups A' and B'. The prognostic nutritional index (PNI; PNI = 10 × serum albumin (g/dL) + 0.005 × blood total lymphocyte count (/mm³)) before surgery and 1 day, 1 week, and 2 weeks after surgery and energy intake 1 and 2 weeks after surgery were compared. Results: After adjustments for age, preoperative subdivided walking ability, and fracture site, there were 51 patients in group A' (mean age 84.6 years) and 51 patients in group B' (mean age 84.7 years). In group A'/group B', PNI was 43.38/42.60 (P = 0.19) before surgery, 33.87/33.31 (P = 0.44) 1 day after surgery, 34.99/32.35 (P = 0.01) 1 week after surgery, and 37.33/35.69 (P = 0.15) 2 weeks after surgery. Energy intake was 1380.8/1203.1 kcal (P = 0.01) 1 week after surgery and 1382.0/1335.6 kcal (P = 0.60) 2 weeks after surgery. Conclusions: PNI and energy intake at 1 week postoperatively were associated with early postoperative nutrition and the recovery of walking ability.

Background factors for intra-operative hypotension during hip fracture repair surgery in the elderly under spinal anesthesia managed by orthopedic surgeons: A retrospective case-control study.

BACKGROUND: Spinal anesthesia is used for femoral trochanteric fracture surgery, but frequently induces hypotension and the causative factors remain unclear. We examined background factors for the use of an intraoperative vasopressor in elderly patients receiving spinal anesthesia for femoral trochanteric fracture surgery. METHODS: We retrospectively analyzed 203 patients >75 years (mean age, 87.9 years) with femoral trochanteric fractures who underwent short nail fixation under orthopedically managed spinal anesthesia at our hospital between April 2020 and July 2023. Patients were divided into two groups: group A (intraoperative vasopressor) and group B (no vasopressor). The following data were compared: age, sex, height, weight, body mass index, antihypertensive medication, years of experience as a primary surgeon, bupivacaine dose, puncture level, anesthesia time, operation time, hemoglobin level and blood urea nitrogen/creatinine ratio on the day of surgery, brain natriuretic peptide level, left ventricular ejection fraction, and percentage of patients operated on the day of transport. RESULTS: There were 65 patients in group A and 138 in group B. The average dose of bupivacaine was 11.7 mg. In a univariate analysis, group A was slightly younger (87.0 vs. 88.3 years), had a higher blood urea nitrogen/creatinine ratio (27.1 vs. 24.5), more frequently received ß-blockers (14.1% vs. 5.8 %) and diuretic medications (21.9% vs. 11.6 %), and had a higher puncture level. A logistic regression analysis identified younger age (p = 0.02) and diuretic medication (p = 0.001) as independent risk factors in group A. Vasopressor use was more frequent at a higher puncture level in group A (57 % for L2/3, 33 % for L3/4, 15 % for L4/5, 0 % for L5/S). CONCLUSIONS: Spinal anesthesia-induced hypotension is attributed to volume deficit or extensive sympathetic blockade and may be prevented by avoiding high puncture levels and increasing preoperative fluid supplementation in patients on diuretics. There is currently no consensus on anesthetic dosages.

Osteogenesis imperfecta with repeated simultaneous bilateral proximal tibial epiphyseal injuries caused by minor trauma: A case report and literature review.

INTRODUCTION: Proximal tibial epiphyseal injuries are rare, accounting for 0.5-3 % of all epiphyseal injuries, of which bilateral cases are extremely rare. Only five cases of bilateral proximal tibial epiphyseal injuries have so far been reported in patients with osteogenesis imperfecta. We herein present a case of repeated bilateral proximal tibial epiphyseal injuries with a diagnosis of osteogenesis imperfecta. We also performed a literature review of 46 cases of bilateral proximal tibial epiphyseal injuries reported since 1955, including 5 of osteogenesis imperfecta. PRESENTATION OF CASE: A 10-year-old boy repeatedly sustained bilateral simultaneous proximal tibial epiphyseal injuries due to minor trauma. Blue sclera was noted and, thus, genetic testing was performed and revealed osteogenesis imperfecta. After the fourth injury, we performed internal fixation with cannulated cancellous screw bilaterally. The patient had a short stature and the marked loss of bone density; therefore, the screw was kept in place until epiphyseal closure and bisphosphonate and human growth hormone were administered to prevent re-fracture and increase bone density and the growth rate. DISCUSSION: The literature review revealed that the mean age of injury was 11.2 years for osteogenesis imperfecta cases and 14.9 years for non-osteogenesis imperfecta cases, with the former being injured at a younger age. CONCLUSION: Osteogenesis imperfecta often causes diaphyseal fractures, which may be attributed to the fragility of the epiphyseal line. Therefore, the possibility of osteogenesis imperfecta needs to be considered when treating patients with epiphyseal injuries at rare sites, particularly younger children.

Breeding of a new potato variety 'Nagasaki Kogane' with high eating quality, high carotenoid content, and resistance to diseases and pests.

'Nagasaki Kogane' is a new potato variety bred from a cross between 'Saikai 35' as a female parent and 'Saikai 33' as a male. 'Saikai 35' is resistant to bacterial wilt, contains the H1 and Rychc genes for resistance to the potato cyst nematode (PCN) and potato virus Y (PVY), respectively, and has high carotenoid content, while 'Saikai 33' has large and high-yielding tubers and is resistant to both bacterial wilt and PCN. The carotenoid content of 'Nagasaki Kogane' is higher than that of 'Dejima', a common double cropping variety. The taste quality of steamed 'Nagasaki Kogane' is comparable to that of 'Inca-no-mezame' tubers, which has high levels of carotenoid, and superior to 'Nishiyutaka', another popular double cropping variety. 'Nagasaki Kogane' is suitable for French fries, because its tuber has high starch content. The marketable yield of 'Nagasaki Kogane' was higher than that of 'Inca-no-mezame' in spring cropping, although it was lower than that of 'Nishiyutaka' in double cropping regions. 'Nagasaki Kogane' tubers are larger on average than 'Inca-no-mezame' tubers in spring cropping. Moreover, the 'Nagasaki Kogane' variety is resistant to PCN and PVY, and exhibits a high level of resistance to bacterial wilt.

[Progress in quantitative ultrasound in measurement of bone quality].

The use of QUS (quantitative ultrasound) for the assessment of skeletal status has been continued and accelerating interest in recent years. The attractive of QUS lies in its low cost, portability, and freedom from ionizing radiation. These benefits, combined with clinical results showing good diagnostic sensitivity and the ability to predict fracture risk, have encouraged further basic investigation.

[Trend of an osteoporosis curative medicine--Who uses what from when to when how?].

About the point of which medicine to use how in the medical treatment of osteoporosis, the large-scale clinical trial performed in Europe and America has been arranging. Especially, about calcium, vitamin D, estrogen, and bisphosphonates medicine can be used now based on the evidence about them. The necessity of medical treatment for the patient diagnosed as osteoporosis according to the criteria established by osteoporosis congress is guaranteed. However, when considering the necessity for prevention of osteoporosis, we would like to know the view about medicating osteopenia group, but there are few bases that for the moment it is important. Moreover, "up to when" in the point whether medical treatment is required, we have to wait for the report of the clinical test of medicine medication over a long period of time which is performed now. However, it is foundations to continue medicine medication as much as possible now, if effective. Although it became clear in estrogen medical treatment that a risk is higher than a benefit by medication examination over a long period of time, as well as this, It is necessary to discuss the benefit and the economic effect of an osteoporosis curative medicine.