Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty.

This phase 3 trial compared the efficacy and safety of rivaroxaban, an oral direct inhibitor of factor Xa, with those of enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty.In this randomized, double-blind study, we assigned 4541 patients to receive either 10 mg of oral rivaroxaban once daily, beginning after surgery, or 40 mg of enoxaparin subcutaneously once daily, beginning the evening before surgery, plus a placebo tablet or injection. The primary efficacy outcome was the composite of deep-vein thrombosis (either symptomatic or detected by bilateral venography if the patient was asymptomatic), nonfatal pulmonary embolism, or death from any cause at 36 days (range, 30 to 42). The main secondary efficacy outcome was major venous thromboembolism (proximal deep-vein thrombosis, nonfatal pulmonary embolism, or death from venous thromboembolism). The primary safety outcome was major bleeding.A total of 3153 patients were included in the superiority analysis (after 1388 exclusions), and 4433 were included in the safety analysis (after 108 exclusions). The primary efficacy outcome occurred in 18 of 1595 patients (1.1\%) in the rivaroxaban group and in 58 of 1558 patients (3.7\%) in the enoxaparin group (absolute risk reduction, 2.6\%; 95\% confidence interval [CI], 1.5 to 3.7; P<0.001). Major venous thromboembolism occurred in 4 of 1686 patients (0.2\%) in the rivaroxaban group and in 33 of 1678 patients (2.0\%) in the enoxaparin group (absolute risk reduction, 1.7\%; 95\% CI, 1.0 to 2.5; P<0.001). Major bleeding occurred in 6 of 2209 patients (0.3\%) in the rivaroxaban group and in 2 of 2224 patients (0.1\%) in the enoxaparin group (P=0.18).A once-daily, 10-mg oral dose of rivaroxaban was significantly more effective for extended thromboprophylaxis than a once-daily, 40-mg subcutaneous dose of enoxaparin in patients undergoing elective total hip arthroplasty. The two drugs had similar safety profiles. (ClinicalTrials.gov number, NCT00329628.

Teriparatide seems to improve recovery after pertrochanteric hip fracture : Comparison with risedronate in a randomized, controlled trial

To compare the effects on fracture recovery of 26 wks' therapy with an oral antiresorptive (risedronate: RIS 35 mg QW) or a bone forming drug (teriparatide: TPTD 20 ug QD) started within 2 wks after osteosynthesis in a pertrochanteric hip fracture in patients with low bone mass. Methods: 224 patients were randomized to study drug and an oral/injectable placebo plus calcium/vitD3 in an osteoporosis trial. The primary outcome was bone mineral density which will be reported elsewhere. We report secondary (Timed Up-and-Go [TUG] test, hip pain, SF-36, safety) and exploratory (radiography) endpoints. Efficacy analyses of the TUG test, patient-rated health status, and hip pain 100 mm Visual Analog Scale were performed with a Mixed-effects Model for Repeated Measures. Results: Mean age was 77 years and 77% were female. The teriparatide group completed the TUG test in a shorter time (LS means 5.7, 4.4, 3.1, and 3.1 seconds less at 6, 12, 18, and 24 wks; overall difference p = 0.021) and reported less hip pain during the test (LS means 8.7, 10.6, 11.9, and 10.2 mm differences at 6, 12, 18, and 26 wks; overall difference p = 0.032). No significant between-group differences in SF-36, Charnley hip pain score, ability to walk or walking aids during follow-up. No patient was radiographically healed at 6 wks, and 90% were healed at 12 wks in both groups. Implant failure (TPTD:7, RIS:8), loss of reduction (TPTD:2, RIS:4) or non-union (0 cases) showed no significant differences. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. Conclusions: Patients treated with teriparatide reported less hip pain and shorter time to complete the TUG test than RIS between 6-26 wks. These outcomes were secondary

Hyperspectral remote sensing to detect leafminer-induced stress in bok choy and spinach according to fertilizer regime and timing.

BACKGROUND:Detection and diagnosis of emerging arthropod outbreaks in horticultural glasshouse crops, such as bok choy and spinach, is both important and challenging. A major challenge is to accurately detect and diagnose arthropod outbreaks in growing crops (changes in canopy size, structure, and composition), and when crops are grown under three fertilization regimes. Day-time remote sensing inside glasshouses is highly sensitive to inconsistent lighting, spectral scattering, and shadows casted by glasshouse structures. To avoid these issues, a unique feature of this study was that hyperspectral remote sensing data were acquired after sunset with an active light source. As part of this study, we describe a comprehensive approach to performance assessment of classification algorithms based on hyperspectral remote sensing data. RESULTS:Based on average hyperspectral remote sensing profiles from individual crop plants, none of the 31 individual spectral bands showed consistent significant response to leafminer infestation and non-significant response to fertilizer regime. Multi-band classification algorithms were subjected to a comprehensive performance assessment to quantify risks of model over-fitting and low repeatability of classification algorithms. The performance assessment of classification algorithms addresses the important 'bias-variance trade-off'. Truly independent validation (training and validation data sets being separated over time) revealed that leafminer infestation could be detected with &gt;99% accuracy in both bok choy and spinach. CONCLUSION:We conclude that detailed hyperspectral profiles (not single spectral bands) can accurately detect and diagnose leafminer infestation over time and across fertilizer regimes. Hyperspectral remote sensing data acquisition at night with an active light source has the potential to enable arthropod infestations in glasshouse-grown crops, such as, bok choy and spinach. In addition, we conclude that effective use and deployment of hyperspectral remote sensing requires thorough performance assessments of classification algorithms, and we propose an analytical performance method to address this important matter. © 2020 The Authors. Pest Management Science published by John Wiley &amp; Sons Ltd on behalf of Society of Chemical Industry