Newcastle approach for the treatment of supra-intercondylar fractures in children

The aim of this study is to evaluate the functional results of open reduction using the Newcastle approach and internal fixation for complex intra-articular distal humeral fractures in children through the report of cases. A retrospective case series of patients who underwent open reduction and internal fixation surgery because of a complex intra-articular distal humeral fracture using the Newcastle approach were reviewed. Minimum follow-up was 2 years. Demographic, clinical, and radiological data were analyzed. Also, Mayo Elbow Performance Score and four-point Likert scale were evaluated. 2 children were included in the final analysis. In both fractures, the approach was sufficient for accurate reduction and the functional outcome on both elbows was satisfactory. The Mayo elbow score was 95 points (excellent results) and the five-point Likert scale, both patients were very satisfied with the outcomes. In the radiographic study, no necrosis or secondary deformities were observed. Our study provides evidence that the Newcastle approach is an alternative to perform open reduction in those children supra-intercondylar fractures that cannot be reduced using a close reduction. To our knowledge, there is not previous paper that has reported the used of this approach in the treatment in this kind of fractures

Separación de fuentes y transcripción musical con deep learning.

El objetivo de este trabajo es conseguir una transcripción MIDI a partir de un archivo MP3 en melodías polifónicas (varias notas sonando al mismo tiempo) y con varios instrumentos sonando a la vez, haciendo uso del deep learning. Para ello primero se separa cada instrumento mediante el uso de la librería Demucs, y luego se entrena un modelo que detecta las notas completas (frames). El deep learning es una herramienta que ha evolucionado en gran medida estos últimos años gracias al avance de la tecnología.<br /

Impact of subtrochanteric fractures in the geriatric population : better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry

Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. Level of evidence: IV. The online version contains supplementary material available at 10.1186/s10195-022-00637-8

Influencia del diseño de alta flexión, con conservación del LCP, en el rango de movimiento tras la implantación de una prótesis total de rodilla

Els nous implants de genoll pretenen millorar la flexió màxima aconseguida amb els implants convencionals. El nostre estudi pretén demostrar que els pacients intervinguts quirúrgicament, per a la implantació d'una artroplàstia total de genoll d'alta flexió, són capaços d'aconseguir un balanç articular i una flexió màxima superior a l'aconseguida pels pacients tractats amb el model convencional. La flexió màxima post-operatòria, a l'any de la intervenció, va ser 13º major en el grup de pacients portadors d'un implant d'alta flexió, respecte al grup de pacients portadors d'un implant convencional. (P 0,05).Los nuevos implantes de rodilla pretenden alcanzar una flexión máxima superior a la conseguida con los implantes convencionales.Nuestro estudio pretende demostrar que los pacientes intervenidos quirúrgicamente, para la implantación de una artroplastia total de rodilla de alta flexión, son capaces de conseguir un rango de movimiento y una flexión máxima superior a la conseguida por los pacientes tratados con el modelo convencional.La flexión máxima postoperatoria, al año de la intervención, fue 13º mayor en el grupo de pacientes portadores de un implante de alta flexión, respecto al grupo de pacientes portadores de un implante convencional. (P 0,05)

Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio : a pooled analysis of 458 population-based studies in Asian and Western countries

Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and nonHDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries. Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group. Results: Since similar to 1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at similar to 0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as similar to 0.7 per decade in Swiss men (equivalent to similar to 26% decline in coronary heart disease risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.Peer reviewe

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Implementación de una unidad de trauma geriátrico

Introducció L'any 1990 es van produir 1,6 milions de fractures de maluc a tot el món i s'estima que aquesta xifra augmentarà a 6 milions l'any 2050. A la Unió Europea es produeixen 600.000 fractures de maluc a l'any, aproximadament, amb un cost global anual de 13.000 milions d'Euros. La incidència a Espanya és de 517 casos per cada 100.000 habitants i per any. L'edat mitjana de 82 anys i un 78% dels pacients són de sexe femení. Els objectius del tractament de la fractura de maluc són preservar la vida i aconseguir una recuperació funcional que permeti el pacient integrar-se de nou en el seu medi habitual. Però, en aquests pacients, la taxa de mortalitat s'eleva durant el primer any d'un 8,4% a un 36%. A l'any de la fractura el 50% presenten dificultats per caminar, el 38-39% presenten dificultat per fer transferències i el 17-19% presenten dificultats per a l&#8217;higiene. Fins a un 90% dels pacients presenten múltiples comorbiditats, entre les quals la malaltia pulmonar obstructiva crònica, la demència, la hipertensió arterial, la patologia cardíaca isquèmica i la diabetis són les més comunes. Les característiques d'aquests pacients, ancians i amb múltiples comorbiditats, va fer sorgir la idea de proporcionar-los una atenció compartida entre cirurgians ortopèdics i geriatres. Aquesta idea inicial ha evolucionat a la tendència actual d'implementar unitats de ortogeriatria que integrin un tractament multidisciplinari. En aquest model a geriatres i traumatòlegs se sumen també anestesistes, rehabilitadors, fisioterapeutes, infermeres i nutricionistes, entre d'altres. Objectius L'objectiu principal d'aquesta tesi doctoral és determinar la demora per a intervenció quirúrgica dels pacients amb fractura de fèmur proximal després de la implementació d'una unitat de ortogeriatria. Els objectius secundaris són determinar el temps d'estada hospitalària, la mortalitat intrahospitalària i als 30 dies, i els reingressos que es produeixen per complicacions mèdiques i traumatològiques. Material i mètodes Durant l'any 2013 (juny-desembre), 2014 i 2015, van ingressar al nostre servei 534 fractures de maluc, de manera consecutiva. Mentre que en els anys 2011, 2012 i 2013 (gener-maig), quan encara no existia la Unitat de Traumatologia Geriàtrica (UTG) van ingressar 501. Les dades recollides prospectivament en el segon període, després de la implementació de la UTG, han estat comparats amb les dades dels pacients que van ingressar en el primer període. Resultats La demora mitjana per a ser intervingut quirúrgicament prèviament a la implementació de la UTG va ser de 2,27 dies (DE = 2,35), mentre que posteriorment va ser de 1,84 (DE = 1,73). (P = 0,0004). L'estada mitjana prèviament a la implementació de la UTG va ser de 11,39 dies (DE = 9,05), mentre que posteriorment va ser de 10,08 (DE = 5,43). (P = 0,0024). La mortalitat en els primers 30 dies després de la fractura de maluc, prèviament a la implementació de la UTG va ser del 7,7%, mentre que posteriorment va ser de l'4,8%. (P = 0,027). Conclusió La implementació d'una unitat de ortogeriatria, per al tractament dels pacients amb fractura de fèmur proximal, que inclou un conjunt de mesures entre les que destaquen la introducció de circuits ràpids de tractament, tractament multidisciplinari integrat i protocols de rehabilitació primerenca postoperatòria, ha permès disminuir de 2,27-1,84 dies el temps de demora mitjà per ser intervingut quirúrgicament després de l'ingrés. El temps d'estada hospitalària s'ha reduït en un temps mitjà d'un dia. La mortalitat dels pacients als 30 dies s'ha reduït en un 2,9%. Els reingressos per complicacions mèdiques o quirúrgiques no s'han incrementat.Introducción En el año 1990 se produjeron 1,6 millones de fracturas de cadera en todo el mundo y se estima que esa cifra aumentará a 6 millones en el año 2050. En la Unión Europea se producen 600.000 fracturas de cadera al año, aproximadamente, con un coste global anual de 13.000 millones de Euros. La incidencia en España es de 517 casos por cada 100.000 habitantes y por año. La edad media de 82 años y un 78% de los pacientes son de sexo femenino. Los objetivos del tratamiento de la fractura de cadera son preservar la vida y conseguir una recuperación funcional que permita al paciente integrarse de nuevo en su medio habitual. Pero, en estos pacientes, la tasa de mortalidad se eleva durante el primer año de un 8,4% a un 36%. Al año de la fractura el 50% presentan dificultades para caminar, el 38-39% presentan dificultades para realizar transferencias y el 17-19% presentan dificultades para el aseo. Hasta un 90% de los pacientes presentan múltiples comorbilidades, entre las que la enfermedad pulmonar obstructiva crónica, la demencia, la hipertensión arterial, la patología cardiaca isquémica y la diabetes son las más comunes. Las características de estos pacientes, ancianos y con múltiples comorbilidades, hizo surgir la idea de proporcionarles una atención compartida entre cirujanos ortopédicos y geriatras. Esa idea inicial ha evolucionado a la tendencia actual de implementar unidades de ortogeriatría que integren un tratamiento multidisciplinar. En este modelo a geriatras y traumatólogos se suman también anestesistas, rehabilitadores, fisioterapeutas, enfermeras y nutricionistas, entre otros. Objetivos El objetivo principal de esta tesis doctoral es determinar la demora para intervención quirúrgica de los pacientes con fractura de fémur proximal tras la implementación de una unidad de ortogeriatría. Los objetivos secundarios son determinar el tiempo de estancia hospitalaria, la mortalidad intrahospitalaria y a los 30 días, y los reingresos que se producen por complicaciones médicas y traumatológicas. Material y métodos Durante el año 2013 (Junio-Diciembre), 2014 y 2015, ingresaron en nuestro servicio 534 fracturas de cadera, de forma consecutiva. Mientras que en los años 2011, 2012 y 2013 (Enero-Mayo), cuando todavía no existía la Unidad de Traumatología Geriátrica (UTG) ingresaron 501. Los datos recogidos prospectivamente en el segundo periodo, tras la implementación de la UTG, han sido comparados con los datos de los pacientes que ingresaron en el primer periodo. Resultados La demora media para ser intervenido quirúrgicamente previamente a la implementación de la UTG fue de 2,27 días (DE=2,35), mientras que posteriormente fue de 1,84 (DE=1,73). (p=0,0004). La estancia media previamente a la implementación de la UTG fue de 11,39 días (DE=9,05), mientras que posteriormente fue de 10,08 (DE=5,43). (p=0,0024). La mortalidad en los primeros 30 días tras la fractura de cadera, previamente a la implementación de la UTG fue del 7,7%, mientras que posteriormente fue del 4,8%. (p = 0,027). Conclusión La implementación de una unidad de ortogeriatría, para el tratamiento de los pacientes con fractura de fémur proximal, que incluye un conjunto de medidas entre las que destacan la introducción de circuitos rápidos de tratamiento, tratamiento multidisciplinar integrado y protocolos de rehabilitación temprana postoperatoria, ha permitido disminuir de 2,27 a 1,84 días el tiempo de demora medio para ser intervenido quirúrgicamente tras el ingreso. El tiempo de estancia hospitalaria se ha reducido en un tiempo medio de un día. La mortalidad de los pacientes a los 30 días se ha reducido en un 2,9%. Los reingresos por complicaciones médicas o quirúrgicas no se han incrementado.Introduction In 1990, there were 1.6 million hip fractures worldwide. This number is expected to reach 6 million by 2050. In the European Union, osteoporosis causes approximately 600.000 hip fractures per year. The annual estimated economic burden for healthcare systems is 13.000 million Euros. The incidence of hip fractures in Spain is 517 cases per 100.000 inhabitants and year. The average age is 82 years and 78% are women. The goal of hip fracture treatment is to return the patient to preoperative levels of function, facilitating return to pre-fracture residence and supporting long-term wellbeing. Mortality rates in hip fracture patients rise from 8.4 to 36% in the first year after surgery. One year after the fracture, 50% have difficulties in walking, 38-39% are not able to transfer from a bed to a chair and 17-19% require aids for bathing and grooming. Up to 90% of patients have several comorbidities. Commonly, these include chronic obstructive pulmonary disease, dementia, high blood pressure, ischemic heart disease, and diabetes. Elderly patients with several comorbidities could benefit from shared care approaches provided by orthopedic surgeons and geriatricians. This cooperation has triggered the current trend of implementing orthogeriatric units that integrate multidisciplinary teams. In this model, several disciplines, besides surgeons and geriatricians, are involved in the care of the patients including anesthesiologists, physical therapists, nurses, and nutritionists. Objectives The main objective of this study is to determine the delay for surgical intervention of patients with proximal femur fracture after the implementation of an orthogeriatric unit. Secondary objectives are to determine the length of hospital stay, in-hospital and 30-day mortality, and readmissions resulting from medical and trauma complications. Material and methods During 2013 (June-December), 2014, and 2015, 534 consecutive hip fractures were treated in our hospital. While in 2011, 2012, and 2013 (January-May), before the orthogeriatric unit (OGU) was created, 501 hip fractures were treated. Data collected prospectively in the second period, after the implementation of the OGU, have been compared with the first period data. Results The mean delay to undergo surgery before the implementation of the OGU was 2.27 days (SD = 2.35), compared to 1.84 (SD = 1.73). (p = 0.0004) for the second period. The average in-hospital stay before the implementation of the OGU was 11.39 days (SD = 9.05), compared to 10.08 (SD = 5.43). (p = 0.0024) after the orthogeriatric model of care was established. 30-day mortality rate after hip fracture, before OGU implementation, was 7.7%, and 4.8% afterward. (p = 0.027). Conclusion The implementation of an orthogeriatric unit for the treatment of patients with a hip fracture which requires a series of measures including the introduction of fast treatment circuits, integrated multidisciplinary treatment, and early postoperative rehabilitation protocols, has allowed a decrease from 2.27 to 1.84 days in the average time to surgery after admission. The length of hospital stay was reduced by an average time of one day. 30-day mortality was reduced by 2.9%. Readmissions for medical or surgical complications did not increase.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique