Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity : Systematic Review and Meta-analysis

Open access via Springer Compact Agreement The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

The influence of hospital-level variables on hip fracture outcomes

Acknowledgements: The authors are grateful to Dr Lorna Aucott for her advice regarding design of the study and statistical analysesPeer reviewedPostprin

A review of trauma and orthopaedic randomised clinical trials published in high-impact general medical journals

Acknowledgements The authors are grateful for Shaun Treweek for his expert insight into the nuances of Randomised Clinical Trial design. Funding The authors did not receive support from any organisation for the submitted work.Peer reviewedPublisher PD

Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? : A systematic review and meta-analysis

Open access via Springer Compact AgreementPeer reviewedPublisher PD

A high anticholinergic burden is associated with a history of falls in the previous year in middle-aged women:findings from the Aberdeen Prospective Osteoporosis Screening Study

APOSS was funded by the Grampian Osteoporosis Trust. A.D.A. received an Aberdeen Summer Research Scholarship supported by the funding from the Grampian Osteoporosis Trust Charity. The funder has no role in design, analysis, interpretation and reporting of the work presented. We gratefully acknowledge the Steering Committee of APOSS for permission to conduct this research.Peer reviewedPostprin

Anticholinergic burden in middle-aged women and recurrent falls in later life : findings from the Aberdeen Prospective Osteoporosis Screening Study (APOSS)

ACKNOWLEDGEMENTS AND FUNDING The Aberdeen Prospective Osteoporosis Screening Study (APOSS) was funded by the Grampian Osteoporosis Trust. SRN received an Aberdeen Summer Research Scholarship supported by funding from the Institute of Applied Health Sciences, University of Aberdeen, UK. The funder had no role in design, analysis, interpretation or reporting of the work presented. We gratefully acknowledge the Steering Committee of APOSS for their permission to conduct this research.Peer reviewedPublisher PD

Anti-cholinergic burden and patient related clinical outcomes in an emergency general surgical setting

We acknowledge the support of the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (BC).Peer reviewedPublisher PD

FMALE score: combining practical risk scales to improve preoperative predictive accuracy in emergency general surgery: a multi-centre prospective cohort study

Our increasingly aging population is associated with older people being admitted to surgical wards at a rate surpassing population growth. 1 Although frailty is not exclusive to older adults, its prevalence is positively associated with age. 2 Hewitt et al. observed frailty to independently predict increased length of hospital stay (LOS), 30-day and 90-day mortality for adults aged ≥65 years admitted to emergency general surgery (EGS). 3 Recent evidence has shown that the association between frailty and poor outcomes, is not limited to older adults, but extends to all adult EGS patients. 4 Although risk stratification tools have been derived for EGS patients, none have included a measure for frailty. 5 Previously, Ablett et al. suggested the MALE score to identify older patients at risk of poorer outcomes who may benefit from comprehensive geriatric assessment based on four characteristics obtained at the point of care: Male, Anaemic, Low albumin, and age Eight-five and over. 6 We aimed to investigate whether the accuracy of MALE score could be augmented, through incorporating physical frailty defined by the Clinical Frailty Scale (CFS), and applied to all EGS adults

SHARP risk score: a predictor of poor outcomes in adults admitted for emergency general surgery: a prospective cohort study

Purpose Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes. Methods We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed. Results The cohort consisted of 419 adult patients between the ages of 16–94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay. Conclusions SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility

Wnt pathway activity in breast cancer sub-types and stem-like cells

INTRODUCTION: Wnt signalling has been implicated in stem cell regulation however its role in breast cancer stem cell regulation remains unclear. METHODS: We used a panel of normal and breast cancer cell lines to assess Wnt pathway gene and protein expression, and for the investigation of Wnt signalling within stem cell-enriched populations, mRNA and protein expression was analysed after the selection of anoikis-resistant cells. Finally, cell lines and patient-derived samples were used to investigate Wnt pathway effects on stem cell activity in vitro. RESULTS: Wnt pathway signalling increased in cancer compared to normal breast and in both cell lines and patient samples, expression of Wnt pathway genes correlated with estrogen receptor (ER) expression. Furthermore, specific Wnt pathway genes were predictive for recurrence within subtypes of breast cancer. Canonical Wnt pathway genes were increased in breast cancer stem cell-enriched populations in comparison to normal breast stem cell-enriched populations. Furthermore in cell lines, the ligand Wnt3a increased whilst the inhibitor DKK1 reduced mammosphere formation with the greatest inhibitory effects observed in ER+ve breast cancer cell lines. In patient-derived metastatic breast cancer samples, only ER-ve mammospheres were responsive to the ligand Wnt3a. However, the inhibitor DKK1 efficiently inhibited both ER+ve and ER-ve breast cancer but not normal mammosphere formation, suggesting that the Wnt pathway is aberrantly activated in breast cancer mammospheres. CONCLUSIONS: Collectively, these data highlight differential Wnt signalling in breast cancer subtypes and activity in patient-derived metastatic cancer stem-like cells indicating a potential for Wnt-targeted treatment in breast cancers