Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors.

BACKGROUND: Global prevalence of osteoporosis and fragility fractures is increasing due to the aging population. Proximal femoral fractures are among the most common orthopedic conditions in elderly that significantly cause health deterioration and mortality. Here, we aimed to evaluate the mortality rates and risk factors, besides the functional outcomes after these injuries. METHODS: In a retrospective cohort study, all patients admitted with a femoral neck or intertrochanteric fracture between 2016 and the end of 2018 were enrolled in this study. Medical records were reviewed to include patients over 60 years of age who had a proximal femoral fracture and had a complete medical record and radiographs. Exclusion criteria included patients with pathological fractures, cancer under active treatment, follow-up loss, and patient access loss. Demographic and clinical features of patients alongside the details of fracture and patient management were recorded and analyzed. In-hospital and post-discharge mortalities due to included types of fractures at one and 12 months were the primary outcome. Modified Harris Hip Scores (mHHS) was the measure of functional outcome. RESULTS: A total of 788 patients including 412 females (52.3%) and 376 males (47.7%) with a mean age of 76.05 ± 10.01 years were included in this study. Among patients, 573 (72.7%) had an intertrochanteric fracture, while 215 (27.3%) had a femoral neck fracture, and 97.1% of all received surgical treatment. With a mean follow-up of 33.31 months, overall mortality rate was 33.1%, and 5.7% one-month and 20.2% 12-months rates. Analysis of 1-month mortality showed a significant mortality difference in patients operated after 48 h of fracture (p = 0.01) and in patients with American Society of Anesthesiologists (ASA) scores of 3-4 compared to ASA scores of 1-2 (p = 0.001). One-year mortality data showed that the mortality rate in femoral neck fractures was lower compared to other types of fracture. Surgical delay of > 48 h, ASA scores of 3-4, and treatment by proximal femoral plate were associated with shorter survival. The overall mean mHHS score was 53.80 ± 20.78. CONCLUSION: We found several risk factors of mortality, including age ≥ 80 years, a > 48-hour delay to surgery, and pre-operative ASA scores of 3-4 in patients with proximal femoral fracture. Furthermore, the use of a proximal femoral plate was a significant risk factor for mortality and lower mHHS scores.

Modeling for extraction of oil from walnut and sesame using batch flow cold press oil extraction system.

In this study, a batch flow oil extraction system was used for extraction of oil from walnut (Juglans regia L.) and Sesamum (Indicum sesame). Sample mass (g), applied pressure (MPa), and processing temperature of oil (°C) were selected as independent variables and oil extraction mass percentage and oil analysis as dependent variables. Response surface methodology was employed for conducting statistical analysis, modeling, and data optimization. The results revealed that the highest percentage of oil extraction for walnut was obtained at a pressure of 10.5 MPa, a temperature of 31.5°C, and a sample weight of 8 g, with a value of 25.36%. Also, the highest percentage of oil extraction for Sesamum was obtained at the pressure of 13.88 MPa, the temperature of 31.5°C, and a sample value of 20 g with a value of 22.4%. Optimal level of independent variables for walnut and sesame were 8.03 g, 10.41 MPa, and 27.37°C; 20 g, 13.88 MPa, and 27°C, respectively. In this optimum condition, the amount of sesame and walnut peroxide was 10 ± 0.03 and 1.9 ± 0.07 (meq O2/kg), respectively. Likewise, the amount of acid for sesame and walnut was 1.53 ± 0.05 and 0.06 ± 0.02 g/%, separately. Linoleic acid (42.7-51.15), oleic acid (38.6-24.03), palmitic acid (10.87-8.21), and stearic acid (5.5-3.39) were the most common fatty acid components in sesame and walnuts, respectively.