Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Salty stories, fresh spaces: Lessons for aquatic protected areas from marine and freshwater experiences

Marine protected areas (MPAs) and freshwater protected areas (FPAs), collectively aquatic protected areas (APAs), share many commonalities in their design, establishment, and management, suggesting great potential for sharing lessons learned. However, surprisingly little has been exchanged to date, and both realms of inquiry and practice have progressed mostly independent of each other. This paper builds on a session held at the 7th World Fisheries Congress in Busan, South Korea, in May 2016, which explored crossover lessons between marine and freshwater realms, and included case studies of four MPAs and five FPAs (or clusters of FPAs) from nine countries. This review uses the case studies to explore similarities, differences, and transferrable lessons between MPAs and FPAs under five themes: (1) ecological system; (2) establishment approaches; (3) effectiveness monitoring; (4) sustaining APAs; and (5) challenges and external threats. Ecological differences between marine and freshwater environments may necessitate different approaches for collecting species and habitat data to inform APA design, establishment and monitoring, but once collected, similar spatial ecological tools can be applied in both realms. In contrast, many similarities exist in the human dimension of both MPA and FPA establishment and management, highlighting clear opportunities for exchanging lessons related to stakeholder engagement and support, and for using similar socio-economic and governance assessment methods to address data gaps in both realms. Regions that implement MPAs and FPAs could work together to address shared challenges, such as developing mechanisms for diversified and sustained funding, and employing integrated coastal/watershed management to address system-level threats. Collaboration across realms could facilitate conservation of diadromous species in both marine and freshwater habitats. Continued exchange and increased collaboration would benefit both realms, and may be facilitated by defining shared terminology, holding cross-disciplinary conferences or sessions, publishing inclusive papers, and proposing joint projects

Donors with group B KIR haplotypes improve relapse-free survival after unrelated hematopoietic cell transplantation for acute myelogenous leukemia

Survival for patients with acute myeloid leukemia (AML) is limited by treatment-related mortality (TRM) and relapse after unrelated donor (URD) hematopoietic cell transplantation (HCT). Natural killer (NK)–cell alloreactivity, determined by donor killer-cell immunoglobulin-like receptors (KIRs) and recipient HLA, correlates with successful HCT for AML. Hypothesizing that donor KIR genotype (A/A: 2 A KIR haplotypes; B/x: at least 1 B haplotype) would affect outcomes, we genotyped donors and recipients from 209 HLA-matched and 239 mismatched T-replete URD transplantations for AML. Three-year overall survival was significantly higher after transplantation from a KIR B/x donor (31% [95% CI: 26-36] vs 20% [95% CI: 13-27]; P = .007). Multivariate analysis demonstrated a 30% improvement in the relative risk of relapse-free survival with B/x donors compared with A/A donors (RR: 0.70 [95% CI: 0.55-0.88]; P = .002). B/x donors were associated with a higher incidence of chronic graft-versus-host disease (GVHD; RR: 1.51 [95% CI: 1.01-2.18]; P = .03), but not of acute GVHD, relapse, or TRM. This analysis demonstrates that unrelated donors with KIR B haplotypes confer significant survival benefit to patients undergoing T-replete HCT for AML. KIR genotyping of prospective donors, in addition to HLA typing, should be performed to identify HLA-matched donors with B KIR haplotypes