Prevalence, incidence and etiology of hyponatremia in elderly patients with fragility fractures

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The multidisciplinary management of hip fractures in older patients

Acknowledgements The authors would like to thank our colleagues for valuable discussion and feedback on the article. These include Jane Thompson (Physiotherapy), Janet Christie (Occupational Therapy), Denise Donald (Discharge Coordinator) and James Duff (Orthogeriatric Specialist Nurse). Miss Riemen is supported by Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (Grant no. WT 085664) and through Clinical Research Fellowship Number 105424/Z/14/Z.Peer reviewedPublisher PD

Prognosis of hyponatremia in elderly patients with fragility fractures

Funding This work is supported by an NHS Research Scotland (NRS) Career Research Fellowship to Dr Soiza.Peer reviewedPublisher PD

The New Injury Severity Score: Better Prediction of Functional Recovery after Musculoskeletal Injury

AbstractObjectivesInjury Severity Score (ISS) is the most widely used method of assessing severity of injury in blunt trauma. It has been recognized that, by only allowing the score to consider the worst injury for each body system, ISS underestimates the problems of multiple musculoskeletal injuries. The New ISS (NISS) allows the three most severe injuries to be scored, irrespective of region affected, and may give better prediction of functional recovery in these patients.MethodsA prospective cohort study of 200 patients with musculoskeletal injuries, examining the predictive value of ISS and NISS on functional recovery as measured by patient-derived outcome measures (Short Form-36, Sickness Impact Profile, and Musculoskeletal Function Assessment).ResultsNISS was greater than ISS in 34 patients (17%). NISS showed closer correlation with total scores and subscores of the outcomes measures than did ISS (Spearman's rho ranked test, P < 0.05).ConclusionsNISS, a simple modification from ISS, better predicts functional outcomes in survivors of musculoskeletal trauma, and offers an improvement in the assessment of effectiveness of trauma care delivery

Molecular gut-content analysis reveals high frequency of \u3ci\u3eHelicoverpa zea\u3c/i\u3e (Lepidoptera: Noctuidae) consumption by \u3ci\u3eOrius insidiosus\u3c/i\u3e (Hemiptera: Anthocoridae) in sweet corn

Management of corn earworm Helicoverpa zea in sweet corn grown for processing can be challenging due to the lack of effective transgenic and chemical control options. However, biological control by generalist predators can provide a significant impact on pests in this cropping system. One of the most ubiquitous predators of H. zea and other lepidopterans is the insidious flower bug, Orius insidiosus. This small hemipteran has been observed as an important mortality agent of H. zea in several cropping systems, but the strength of the trophic connection between these species has not been documented in sweet corn. Molecular gut-content analysis was conducted to test field-collected O. insidiosus for the presence of H. zea DNA using species-specific PCR primers developed and optimized for this project. Controlled feeding trials determined that the detectability half-life of this technique was 2.32 h. At peak predation in late August, 32% of O. insidiosus tested positive for H. zea DNA. The date of peak predation also corresponded with peak silking of sweet corn plants, which is the most attractive crop growth stage to both H. zea and O. insidiosus. These results indicate that within a short window prior to collection from the field, on the peak date of predation, approximately one third of O. insidiosus in sweet corn had consumed one to two H. zea eggs and/or first instar larvae. The demonstration of this high frequency of predation allows for the assertion that O. insidiosus is a critical mortality agent of H. zea in sweet corn, and conservation biological control practices should be explored to protect and promote this key predator

Proinflammatory Markers in Prediction of Posttraumatic Psychological Symptoms: A Prospective Cohort Study

Introduction. Posttraumatic psychopathology (PTP) describes the spectrum of conditions that can complicate the recovery from commonly occurring musculoskeletal trauma. There is a clear association with the activation of the hypothalamic-pituitary-adrenal axis (HPAA), and we wished to examine the predictive value of proinflammatory markers of the HPAA and of the GABA, which acts as an inhibitory regulator. Methods. Levels of proinflammatory markers and GABA were measured in 84 patients who had suffered musculoskeletal injuries requiring hospitalisation. PTP was assessed by the use of the General Health Questionnaire (GHQ) at presentation and again at two- and six-month reviews. Results. Significant psychological disturbance was noted in 39% of patients at two months and falling back to 18% by six months. There was no correlation between any of the markers tested at presentation and PTP at follow-up. Discussion. The HPAA response to trauma and the development of PTP are extremely complex. It is unlikely that a simple blood assay will provide significant predictive information, while incident specific information and patient perception are of more practical use

Antigen depot is not required for alum adjuvanticity

Alum adjuvants have been in continuous clinical use for more than 80 yr. While the prevailing theory has been that depot formation and the associated slow release of antigen and/or inflammation are responsible for alum enhancement of antigen presentation and subsequent T- and B-cell responses, this has never been formally proven. To examine antigen persistence, we used the chimeric fluorescent protein EαGFP, which allows assessment of antigen presentation in situ, using the Y-Ae antibody. We demonstrate that alum and/or CpG adjuvants induced similar uptake of antigen, and in all cases, GFP signal did not persist beyond 24 h in draining lymph node antigen-presenting cells. Antigen presentation was first detectable on B cells within 6–12 h of antigen administration, followed by conventional dendritic cells (DCs) at 12–24 h, then finally plasmacytoid DCs at 48 h or later. Again, alum and/or CpG adjuvants did not have an effect on the magnitude or sequence of this response; furthermore, they induced similar antigen-specific T-cell activation in vivo. Notably, removal of the injection site and associated alum depot, as early as 2 h after administration, had no appreciable effect on antigen-specific T- and B-cell responses. This study clearly rules out a role for depot formation in alum adjuvant activity

Variation in physical development in schoolboy rugby players: can maturity testing reduce mismatch?

Objectives This study set out to pursue means of reducing mismatch in schoolboy rugby players. The primary objective was to determine whether application of previously reported thresholds of height and grip strength could be used to distinguish those 15-year-old boys appropriate to play under-18 school rugby from their peers. A secondary objective was to obtain normative data for height, weight and grip strength and to assess the variation within that data of current schoolboy rugby players.Design Cross-sectional cohort study.Setting 3 Scottish schools and ‘Regional Assessment Centres’ organised by the Scottish Rugby Union.Participants 472 rugby playing youths aged 15 years (Regional Assessment Centres) and 382 schoolboys aged between 12 and 18 years (three schools).Outcome measures Height, weight and grip strength.Results 97% of 15-year-olds achieved the height and grip strength thresholds based on previous reported values. Larger mean values and wide variation of height, weight and grip strength were recorded in the schoolboy cohort. However, using the mean values of the cohort of 17-year-olds as a new threshold, only 7.7% of 15-year-olds would pass these thresholds.Conclusions Large morphological variation was observed in schoolboy rugby players of the same age. Physical maturity tests described in earlier literature as pre-participation screening for contact sports were not applicable to current day 15-year-old rugby players. New criteria were measured and found to be better at identifying those 15-year-old players who had sufficient physical development to play senior school rugby

Systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip

Objectives: To assess the clinical effectiveness and cost-effectiveness of minimal incision approaches to total hip replacement (THR) for arthritis of the hip. Data sources: Major electronic databases were searched from 1966 to 2007. Relevant websites were also examined and experts in the field were consulted. Review methods: Studies of minimal (one or two) incision THR compared with standard THR were assessed for inclusion in the review of clinical effectiveness. A systematic review of economic evaluations comparing a minimal incision approach to standard THR was also performed and the estimates from the systematic review of clinical effectiveness were incorporated into an economic model. Utilities data were sourced to estimate quality-adjusted life-years (QALYs). Due to lack of data, no economic analysis was conducted for the two mini-incision surgical method. Results: Nine randomised controlled trials (RCTs), 17 non-randomised comparative studies, six case series and one registry were found to be useful for the comparison of single mini-incision THR with standard THR. One RCT compared two mini-incision THR with standard THR, and two RCTs, five non-randomised comparative studies and two case series compared two mini-incision with single mini-incision THR. The RCTs were of moderate quality. Most had fewer than 200 patients and had a follow-up period of less than 1 year. The single mini-incision THR may have some perioperative advantages, e.g. blood loss [weighted mean difference (WMD) –57.71 ml, p £30,000) if recovery was 1.5 weeks faster. A threshold analysis around risk of revision showed, using the same cost per QALY threshold, mini-incision THR would have to have no more than a 7.5% increase in revisions compared with standard THR for it to be no longer considered cost-effective (one more revision for every 200 procedures performed). Further sensitivity analysis involved relaxing assumptions of equal long-term outcomes where possible. and broadly similar results to the base-case analysis were found in this and further sensitivity analyses. Conclusions: Compared with standard THR, minimal incision THR has small perioperative advantages in terms of blood loss and operation time. It may offer a shorter hospital stay and quicker recovery. It appears to have a similar procedure cost to standard THR, but evidence on its longer term performance is very limited. Further long-term follow-up data on costs and outcomes including analysis of subgroups of interest to the NHS would strengthen the current economic evaluation.The Health Services Research Unit and the Health Economics Research Unit are both core funded by the Chief Scientist Office of the Scottish Government Health Directorates.Peer reviewedPublisher PD