Multidisciplinary Approach to Reduce Postoperative Complications and Improve the Activity of Patients with Hip Fracture: A 24-month Follow-up Survey

Multidisciplinary approaches such as fracture liaison services (FLS) have been introduced in some countries to reduce medical complications and secondary fractures in patients with fragility hip fracture. We aimed to investigate outcomes in patients with fragility hip fracture following the introduction of FLS. Patients > 50 years old who experienced fragility hip fractures between January 1, 2015 and December 31, 2017 were enrolled, and divided into a control group (without FLS; 94 patients) and FLS group (373 patients). We found that the time from injury to surgery decreased significantly from 2.42 to 1.83 days (p = 0.003), the proportion of patients who underwent surgery within 36 h of injury increased significantly (p = 0.014), and the number of cases with complications after admission decreased significantly (p = 0.004) in the FLS group. Patients with a Barthel index ≥ 80 were more common in the FLS than the control group at 6 , 12, and 24 months following injury (p = 0.046 , 0.018, and 0.048, respectively). Multiple logistic regression analysis revealed the factors associated with postoperative complications and death within 12 or 24 months after injury. Our results indicate that FLS contributed to earlier recovery, rehabilitation following surgery and rehabilitation of medical complications following admission; improved patient activity; and decreased secondary hip fractures

Accuracy of Acetabular Cup Implantation, as a Function of Body Mass Index and Soft-tissue Thickness, with a Mechanical Intraoperative Support Device: A Retrospective Observational Study

HipCOMPASS, a mechanical intraoperative support device used in total hip arthroplasty (THA), improves the cup-alignment accuracy. However, the alignment accuracy achieved by HipCOMPASS has not been specifically examined in obese patients. In this study, we retrospectively evaluated the relation between alignment accuracy and several obesity-related parameters in 448 consecutive patients who underwent primary THA using HipCOMPASS. We used computed tomography (CT) to measure the preoperative soft-tissue thickness of the anterior-superior iliac spine (ASIS) and pubic symphysis and the differences between preoperative and postoperative cup angle based on the cup-alignment error. We found significant correlations between the absolute value of radiographic anteversion difference and body mass index (r = 0.205), ASIS thickness (r = 0.419), and pubic symphysis thickness (r = 0.434). The absolute value of radiographic inclination difference was significantly correlated with ASIS (r = 0.257) and pubic symphysis thickness (r = 0.202). The receiver operating characteristic curve showed a pubic symphysis thickness of 37.2 mm for a ≥ 5° implantation error in both radiographic inclination and anteversion simultaneously. The cup-alignment error for HipCOMPASS was large in patients whose pubic symphysis thickness was ≥ 37.2 mm on preoperative CT. Our results indicate that methods other than HipCOMPASS, including computed tomography-based navigation systems, might be preferable in obese patients

Release of nitrogen and phosphorus from aquaculture farms to Selangor River, Malaysia

The release of nitrogen and phosphorus from aquaculture ponds to Selangor River, Malaysia was estimated. The concentrations of nitrogen and phosphorus in aquaculture ponds were always higher than those in the river, their primary water source, indicating that the aquaculture ponds are sources of nitrogen and phosphorus in Selangor River. From the careful interview with aquaculture managers, the frequency of water exchange, the number of harvesting, and the amount of feeds added, the total volume of water released to the Selangor River was also obtained. The total amount of nitrogen and phosphorus added to each aquaculture pond was estimated to be about 700 kg N and 60 kg P per year, respectively. About 100-200 kg N and 10-15 kg P were estimated to be released with the waste water per pond per year, accounting for 20-30% of nitrogen and phosphorus in added feeds. It is important for us to precisely estimate the fates of nutrients for the better management and sustainable development of aquaculture industries. Our data may help to improve aquaculture management in future

Three-dimensional Assessment of Femoral Head Coverage in Normal and Dysplastic Hips: A Novel Method

The acetabular coverage of the femoral head has been assessed in two-dimensions as the projected covered area or the covered angle on plain radiographs. We present a novel method of the three-dimensional assessment of femoral head coverage obtained by evaluating the covered volume of the femoral head in both normal and dysplastic hips. We also assessed the covered angles on the vertical slices passing through the center of the femoral head. The mean covered volume of the femoral head was 57.4% in normal hips and 26.6% in dysplastic hips. In dysplastic hips, the L-CE, A-CE, and P-CE angles were 7.7°, 21.8°, and 95.8°, respectively, while the acetabular angle was 27.5°. In normal hips, the CE angles were 34.0°, 56.8°, and 109.4°, respectively, while the acetabular angle was 7.2°. Our study suggests the usefulness of a novel 3D assessment for acetabular coverage of the femoral head. This assessment provided the precise 3D information necessary to diagnose hip dysplasia and assess the deficiency of acetabular coverage in these patients. Moreover, we may detect a cut-off between normal and dysplastic hips in the 3D assessment by assessing a large number of dysplastic hips both morphologically and using the new assessment

Investigation of effectiveness of edge elements

The effectiveness of the edge element is investigated by comparing systematically the number of unknown variables with that of the nodal element. It is shown that the edge element is superior to the nodal element from the standpoints of computer storage and CPU time. The 3-D periodic boundary condition for the edge element is also derived in order to reduce the computer storage and the CPU time</p

Comparing the Effects of Canagliflozin vs. Glimepiride by Body Mass Index in Patients with Type 2 Diabetes and Chronic Heart Failure : A Subanalysis of the CANDLE Trial

Background: We present results of a 24-week comparative study of the effects of the sodium–glucose cotransporter 2 (SGLT2) inhibitor canagliflozin vs. the sulfonylurea glimepiride, by baseline body mass index (BMI), in patients with type 2 diabetes and chronic heart failure. Methods: We conducted a post hoc analysis of the CANDLE trial. This subanalysis evaluated NT-proBNP, BMI, and other laboratory parameters, according to the subgroups stratified by BMI ≥ 25 kg/m2 vs. BMI < 25 kg/m2. Results: A group ratio of proportional changes in the geometric means of NT-proBNP was 0.99 (p = 0.940) for the subgroup with BMI ≥ 25 kg/m2 and 0.85 (p = 0.075) for the subgroup with BMI < 25 kg/m2, respectively. When baseline BMI was modeled as a continuous variable, results for patients with BMI < 30 kg/m2 showed a slightly smaller increase in NT-proBNP in the canagliflozin group vs. the glimepiride group (p = 0.295); that difference was not seen among patients with BMI ≥30 kg/m2 (p = 0.948). Irrespective of obesity, the canagliflozin group was associated with significant reduction in BMI compared to the glimepiride group. Conclusion: There was no significant difference in the effects of canagliflozin, relative to glimepiride, on NT-proBNP concentrations irrespective of baseline obesity. UMIN clinical trial registration number: UMIN000017669

Relationship between the Hip Abductor Muscles and Abduction Strength in Patients with Hip Osteoarthritis

This study aimed to determine which muscle the gluteus maximus, gluteus medius, gluteus minimus (Gmin), or tensor fasciae latae (TFL) contributes most to hip abduction strength and to identify effective sites for cross-sectional area (CSA) Gmin and TFL measurement in hip osteoarthritis (OAhip) patients. Twenty-eight patients with OAhip were included. The muscle CSA and volume were determined using magnetic resonance imaging. Peak isometric strength was determined using hand-held dynamometry. Muscle volumes were normalized to the total muscle volume of hip abductors. Multiple regression analysis was performed. The difference between the CSA of Gmin and TFL was calculated, and correlations with volume and muscle strength were determined. Gmin volume was related to abductor muscle strength (p=0.042). The peak CSA of the Gmin correlated with muscle volume and strength. The CSA of the TFL correlated with volume, with no difference between the CSA of the most protruding part of the lesser trochanter and peak CSA. Gmin volume was strongly related to abductor muscle strength. Peak CSA is a useful parameter for assessing the CSA of the Gmin among patients with OAhip. The CSA of the TFL should be measured at the most protruding part of the lesser trochanter