Who Is Treating Periprosthetic Femur Fractures? An Analysis of the Periprosthetic Research Consortium

Background: Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based on surgical training or patient factors. Methods: This multicenter retrospective study evaluated patients surgically treated for Vancouver B PPFF after THA between 2014 and 2019. Patients from 11 academic centers located in the United States were included in this study. Surgical outcomes and patient demographics were evaluated based on surgeon training, surgical treatment type, and institution. Results: Presence of Vancouver B2 (odds ratio [OR]: 0.02, P \u3c .001) or B3 (OR: 0.04, P \u3c .001) fractures were independent risk factors for treatment with rTHA. Treatment by a trauma (OR: 12.49, P \u3c .001) or other-specified surgeon (OR: 13.63, P \u3c .001) were independent risk factors for ORIF repair of Vancouver B fractures. There were no differences in outcomes based on surgeon subspecialty training. Conclusions: This study showed the trends in surgeons who surgically manage Vancouver B fractures at 11 major academic institutions and highlighted that regardless of surgical training or surgical treatment type, postoperative outcomes following management of PPFF were similar

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Organochlorine Pollutants in Western Antarctic Peninsula Sediments and Benthic Deposit Feeders

Sediments and benthic deposit feeding holothurians were collected near the Palmer Long Term Ecological Research grid during the austral winter of 2008. Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were measured in Western Antarctic Peninsula continental shelf sediments, porewater, and benthic biota. Concentrations and fluxes in sediments decreased sharply away from the tip of the peninsula toward its interior. Sedimentary PCB fluxes were an order of magnitude lower than reported elsewhere, supporting the notion of a pristiner Antarctic environment. Hexa-chlorinated biphenyls dominated (40–100%) the PCB profiles in the sediments, while trichlorinated biphenyl 28 was the most abundant PCB congener in the porewater. PCB and OCP concentrations in holothurians were comparable to concentrations in other low trophic level biota in the Antarctic food web (i.e., krill). The partitioning of PCBs and OCPs between the sediments and porewater can be explained by a dual-mode model, which included both organic carbon and black carbon as partitioning media. Alternatively, a simpler one-parameter prediction assuming coal tar-like organic carbon performed equally well in explaining porewater concentrations The majorities of PCBs (63–94%) in the Western Antarctic Peninsula sediments were bound to black carbon or recalcitrant tar-like organic carbon, thereby lowering porewater concentrations. PCBs and OCPs in the holothurians were in equilibrium with those in the porewater

Organochlorine Pollutants in Western Antarctic Peninsula Sediments and Benthic Deposit Feeders

Sediments and benthic deposit feeding holothurians were collected near the Palmer Long Term Ecological Research grid during the austral winter of 2008. Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were measured in Western Antarctic Peninsula continental shelf sediments, porewater, and benthic biota. Concentrations and fluxes in sediments decreased sharply away from the tip of the peninsula toward its interior. Sedimentary PCB fluxes were an order of magnitude lower than reported elsewhere, supporting the notion of a pristiner Antarctic environment. Hexa-chlorinated biphenyls dominated (40–100%) the PCB profiles in the sediments, while trichlorinated biphenyl 28 was the most abundant PCB congener in the porewater. PCB and OCP concentrations in holothurians were comparable to concentrations in other low trophic level biota in the Antarctic food web (i.e., krill). The partitioning of PCBs and OCPs between the sediments and porewater can be explained by a dual-mode model, which included both organic carbon and black carbon as partitioning media. Alternatively, a simpler one-parameter prediction assuming coal tar-like organic carbon performed equally well in explaining porewater concentrations The majorities of PCBs (63–94%) in the Western Antarctic Peninsula sediments were bound to black carbon or recalcitrant tar-like organic carbon, thereby lowering porewater concentrations. PCBs and OCPs in the holothurians were in equilibrium with those in the porewater