Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

<p>Abstract</p> <p>Background</p> <p>While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.</p> <p>Methods</p> <p>A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.</p> <p>Results</p> <p>Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.</p> <p>Conclusions</p> <p>Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.</p

The study of dental occlusion in ancient skeletal remains from Mallorca (Spain): A new approach based on dental clinical practice

Occlusal characteristics, fundamental to assess the presence of malocclusion, have been often unexplored in bioarchaeological analyses. This is largely due to the fragmented condition of the skeletal remains. By applying a method that considers dental and maxillary features useful to evaluate occlusion in ancient fragmentary material, the purpose of this work is to define the occlusal features and explore the causes of malocclusion in a mediaeval population from Mallorca. The findings of this study suggest that normocclusion was present in ca. 60% of the individuals ($N$=31), and that some characteristics, such as molar relationship, were slightly different from those of modern populations. The analysis of the occlusal features revealed for example that open-bite was absent in 85% of the sample, posterior open-bite was completely absent and overbite and overjet were normal in around 90% of the individuals. Statistically significant correlations between canine and molar relationships and between molar relationship and dental wear of the superior and inferior canines and incisors were observed. In addition, wear could affect the curve of Spee. All these findings strengthen the hypothesis that in ancient times malocclusion was not as generalized as in modern times. Although the factors that lead to malocclusion throughout centuries could have several causes, we suggest that in this population dental wear, which is strongly associated with the diet, was the fundamental causing factor

Entheseal changes and functional implications of the humeral medial epicondyle

Longitudinal rotation of the forearm (pronosupination) is an essential component of human manipulative tasks. The efficiency of this movement is dependent not only on the rotatory muscles but also on several morphological and structural features of the upper limb. In a recent study, we observed that the size and orientation of the humeral medial epicondyle played an important role in forearm rotatory ability. We further observed that the forearm muscular activity, specifically the motion of pronation, promotes radial curvature, which, in turn, enhances rotational efficiency. In this study, we aim to test whether the orientation of the medial epicondyle is an activity-dependent parameter or whether it is an invariable morphological feature characteristic of the human skeleton. We analysed the upper limb entheseal changes in 30 human skeletons and assessed the role of several functional groups in the anteroposterior and proximo-distal orientation of the medial epicondyle. Our results indicate that the orientation of the medial epicondyle is partially an activity-dependent feature basically determined by elbow flexor-extensors and hand and wrist flexors. The orientation of the medial epicondyle towards more posterior and proximal positions causes a gain of efficiency in the pronation range when the elbow is extended and in the supination range when the elbow is flexed. Therefore, we suggest that the medial epicondyle of the humerus is a structure involved in the manipulative capacities of the human upper limb, and its orientation presents a range of variation that may be associated with the functional enhancement of these abilities

A proposal for a low-frequency axion search in the 1–2 μ eV range and below with the babyIAXO magnet

In the near future BabyIAXO will be the most powerful axion helioscope, relying on a custom-made magnet of two bores of 70 cm diameter and 10 m long, with a total available magnetic volume of more than 7 m3. In this document, it proposes and describe the implementation of low-frequency axion haloscope setups suitable for operation inside the BabyIAXO magnet. The RADES proposal has a potential sensitivity to the axion-photon coupling ga down to values corresponding to the KSVZ model, in the (currently unexplored) mass range between 1 and 2 eV, after a total effective exposure of 440 days. This mass range is covered by the use of four differently dimensioned 5-meter-long cavities, equipped with a tuning mechanism based on inner turning plates. A setup like the one proposed will also allow an exploration of the same mass range for hidden photons coupled to photons. An additional complementary apparatus is proposed using LC circuits and exploring the low energy range (≈ 10−4 − 10−1 eV). The setup includes a cryostat and cooling system to cool down the BabyIAXO bore down to about 5 K, as well as an appropriate low-noise signal amplification and detection chain

Osseointegrated amputation prostheses and implanted electrodes

The load transfer from the external prosthesis to the residual limb via the socket can cause significant stress on the soft tissues, leading to irritation and skin ulcers. Osseointegrated bone-anchored prostheses systems create a direct structural and functional connection between the prosthesis and residual skeleton. Up to date, standardized implant systems, surgical techniques, and postoperative rehabilitation protocols have been developed for osseointegrated prostheses for the rehabilitation of amputees (OPRA), which has resulted in better functionality, fewer complications, and a better quality of life for implant recipients. The OPRA implant systems can now incorporate neuromuscular electrodes to facilitate myoelectric control and sensory feedback, which is especially important for upper extremity amputees. The latest development, called the osseointegrated human-machine gateway, allows for permanent implantation of neuromuscular electrodes, which provide long-term stable signals for myoelectric control, independent of limb position or environmental conditions, as well as artificial sensory feedback. In addition, the modular design of this system allows any part to be upgraded or replaced with minimal disturbance to the other components. The osseointegrated implants and the human-machine gateway represent frontiers in amputee rehabilitation

The value of the continuous genotyping of multi-drug resistant tuberculosis over 20 years in Spain

Molecular epidemiology of circulating clinical isolates is crucial to improve prevention strategies. The Spanish Working Group on multidrug resistant tuberculosis (MDR-TB) is a network that monitors the MDR-TB isolates in Spain since 1998. The aim of this study was to present the study of the MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) patterns in Spain using the different recommended genotyping methods over time by a national coordinated system. Based on the proposed genotyping methods in the European Union until 2018, the preservation of one method, MIRU-VNTR, applied to selected clustered strains permitted to maintain our study open for 20 years. The distribution of demographic, clinical and epidemiological characteristics of clustered and non-clustered cases of MDR/XDR tuberculosis with proportion differences as assessed by Pearson’s chi-squared or Fisher’s exact test was compared. The differences in the quantitative variables using the Student's-t test and the Mann–Whitney U test were evaluated. The results obtained showed a total of 48.4% of the cases grouped in 77 clusters. Younger age groups, having a known TB case contact (10.2% vs 4.7%) and XDR-TB (16.5% vs 1.8%) were significantly associated with clustering. The largest cluster corresponded to a Mycobacterium bovis strain mainly spread during the nineties. A total of 68.4% of the clusters detected were distributed among the different Spanish regions and six clusters involving 104 cases were grouped in 17 and 18 years. Comparison of the genotypes obtained with those European genotypes included in The European Surveillance System (TESSy) showed that 87 cases had become part of 20 European clusters. The continuity of MDR strain genotyping in time has offered a widespread picture of the situation that allows better management of this public health problem. It also shows the advantage of maintaining one genotyping method over time, which allowed the comparison between ancient, present and future samples

Study protocol for a randomized clinical trial to assess 7 versus 14-days of treatment for Pseudomonas aeruginosa bloodstream infections (SHORTEN-2 trial)

Background Research priorities in Antimicrobial Stewardship (AMS) have rapidly evolved in the last decade. The need for a more efficient use of antimicrobials have fueled plenty of studies to define the optimal duration for antibiotic treatments, and yet, there still are large areas of uncertainty in common clinical scenarios. Pseudomonas aeruginosa has been pointed as a priority for clinical research, but it has been unattended by most randomized trials tackling the effectiveness of short treatments. The study protocol of the SHORTEN-2 trial is presented as a practical example of new ways to approach common obstacles for clinical research in AMS. Objective To determine whether a 7-day course of antibiotics is superior to 14-day schemes for treating bloodstream infections by P. aeruginosa (BSI-PA). Methods A superiority, open-label, randomized controlled trial will be performed across 30 Spanish hospitals. Adult patients with uncomplicated BSI-PA will be randomized to receive a 7 versus 14-day course of any active antibiotic. The primary endpoint will be the probability for the 7-day group of achieving better outcomes than the control group, assessing altogether clinical effectiveness, severe adverse events, and antibiotic exposure through a DOOR/RADAR analysis. Main secondary endpoints include treatment failure, BSI-PA relapses, and mortality. A superiority design was set for the primary endpoint and non-inferiority for treatment failure, resulting in a sample size of 304 patients. Conclusions SHORTEN-2 trial aligns with some of the priorities for clinical research in AMS. The implementation of several methodological innovations allowed overcoming common obstacles, like feasible sample sizes or measuring the clinical impact and unintended effects