Predictors of mortality in the elderly patient with a fracture of the odontoid process.

AIMS: Fracture of the odontoid process (OP) in the elderly is associated with mortality rates similar to those of hip fracture. The aim of this study was to identify variables that predict mortality in patients with a fracture of the OP, and to assess whether established hip fracture scoring systems such as the Nottingham Hip Fracture Score (NHFS) or Sernbo Score might also be used as predictors of mortality in these patients. PATIENTS AND METHODS: We conducted a retrospective review of patients aged 65 and over with an acute fracture of the OP from two hospitals. Data collected included demographics, medical history, residence, mobility status, admission blood tests, abbreviated mental test score, presence of other injuries, and head injury. All patients were treated in a semi-rigid cervical orthosis. Univariate and multivariate analysis were undertaken to identify predictors of mortality at 30 days and one year. A total of 82 patients were identified. There were 32 men and 50 women with a mean age of 83.7 years (67 to 100). RESULTS: Overall mortality was 14.6% at 30 days and 34.1% at one year. Univariate analysis revealed head injury and the NHFS to be significant predictors of mortality at 30 days and one year. Multivariate analysis showed that head injury is an independent predictor of mortality at 30 days and at one year. The NHFS was an independent predictor of mortality at one year. The presence of other spinal injuries was an independent predictor at 30 days. Following survival analysis, an NHFS score greater than 5 stratified patients into a significantly higher risk group at both 30 days and one year. CONCLUSION: The NHFS may be used to identify high-risk patients with a fracture of the OP. Head injury increases the risk of mortality in patients with a fracture of the OP. This may help to guide multidisciplinary management and to inform patients. This paper provides evidence to suggest that frailty rather than age alone may be important as a predictor of mortality in elderly patients with a fracture of the odontoid process. Cite this article: Bone Joint J 2019;101-B:253-259.

A microbiological survey of selected Alberta-grown fresh produce from farmers' markets in Alberta, Canada.

Previously there was no available information on the levels of indicator bacteria and the prevalence of pathogens in fresh produce grown in Alberta, Canada. Baseline information on the occurrence and levels of Escherichia coli and the prevalence of foodborne pathogens in selected produce items available to consumers from farmers' and public markets in two large urban centers and surrounding areas in Alberta was obtained. A total of 10 large markets with between 1 and 12 produce vendors and 26 small markets with between 1 and 6 produce vendors were sampled from 21 June to 7 October 2007. Lettuce (128 samples), spinach (59 samples), tomatoes (120 samples), carrots (206 samples), green onions (129 samples), and strawberries (31 samples) were analyzed for E. coli, Salmonella, E. coli O157:H7, and Campylobacter spp. Lettuce, spinach, green onion, and strawberry samples were also tested for the presence of Cryptosporidium spp. Information on whether produce was grown using organic or conventional practices was obtained from the produce vendors. E. coli was isolated from 8.2% of the samples that included lettuce, spinach, carrots, and green onions. The bacterial counts ranged from <0.48 to >3.04 Log most probable number per g. E. coli was not isolated from tomatoes or strawberries. The percentage of positive samples ranged from 4.4% for carrots to 27.1% for spinach. Salmonella, E. coli O157:H7, and Campylobacter spp. were not isolated from any of the samples. Cryptosporidium was identified by PCR in one sample of spinach (0.6% of the samples).

The symbiotic water mite Unionicola formosa (Acari: Unionicolidae) ingests mucus and tissue of its molluscan host.

Unionicola formosa is a symbiotic water mite that passes most of its life cycle in the mantle cavity of freshwater mussels. Although mites of this genus are often referred to as parasitic, little is known about their nutritional biology. A few species reportedly pierce the gill of a host mussel and ingest tissue or hemolymph. The present study was undertaken to identify possible sources of nutrition for U. formosa. To determine if mites ingested particulate matter in the mucous strand produced by a mussel during feeding, mussels with resident mites were exposed to a suspension of fluorescent microspheres. There was no evidence that U. formosa ingested the beads. Histochemical staining did, however, indicate a mucous material present in the midgut of the mites. Sodium dodecyl sulfate-polyacrylamide gel electrophoretic assays revealed a high molecular weight component, consistent with a mucopolysaccharide, present both in the mussel gill and the mites. Results from western blots and an immunoaffinity binding assay with antibodies against mussel gill tissue and hemolymph also indicated that mites ingested host tissue. Whereas U. formosa probably does not ingest particulate material acquired by its host's suspension feeding, it is apparent that this mite utilizes host mucus, gill tissue, or hemolymph for at least part of its nutrition.

Quantitative Analysis of the Structure and Function of the Marsupial Gills of the Freshwater Mussel Anodonta cataracta.

Gravid females of Anodonta cataracta incubate shelled larvae (glochidia) in the water tubes of their outer demibranchs which, in turn, undergo extensive morphological changes in becoming marsupia. In this study, the brooding gills of A. cataracta were compared to the non-marsupial demibranchs of females and the gills of males. Scanning electron microscopy and video enhanced light microscopy were used, and computer-generated 3D-reconstructions of gill tissue were also prepared from light micrographs of serial histological sections. Marsupial gills possess a tripartite system of water tubes that are not present in non-marsupial gills and include two secondary water channels and one primary water tube (brood chamber) containing glochidia. The lateral dimension (width) of water tubes of the marsupial gills increases nearly 30-fold during brooding, but the anterior-posterior length of the tubes is unaffected. No apparent changes in the morphology of the non-marsupial inner demibranchs were observed. Glochidia are effectively isolated from the surrounding water by secondary septa, positioned between the primary and secondary water tubes. Secondary septa are present during brooding and immediately after larval release, but are not in evidence among females during non-reproductive periods. Quantification by 3D reconstruction revealed that, although secondary water tubes are smaller than the primary water tubes of non-marsupial gills and non-gravid marsupial gills, collectively they provide about the same cross-sectional area as the primary water tubes that are lost to water transport by occlusion with glochidia. However, considering the fluid dynamics of the ciliary gill pump, net water transport through the lumina of marsupial gills is reduced to only about 16% of that in non-gravid marsupial demibranchs.