Global longitudinal strain is compromised in patients with elevated blood cobalt levels secondary to metal-on-metal hip implants

Metal-on-metal (MoM) hip arthroplasties are known to release metal ions including cobalt into the blood stream. Elevated blood cobalt at levels over 250µg/l have been shown to be a risk factor for developing systemic complications including neurological, endocrine and cardiovascular symptoms. Published case reports document cardiomyopathy, a need for cardiac transplantation and, in some cases, death in patients with severely elevated blood cobalt. Clinical studies have found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. The extent of cardiovascular injury in patients with elevated blood cobalt levels above 250µg/l has not previously been examined and is the focus of the current study

Effect of Phosphorus and Strontium Additions on Formation Temperature and Nucleation Density of Primary Silicon in Al-19 Wt Pct Si Alloy and Their Effect on Eutectic Temperature

The influence of P and Sr additions on the formation temperature and nucleation density of primary silicon in Al-19 wt pct Si alloy has been determined, for small volumes of melt solidified at cooling rates _T of ~0.3 and 1 K/s. The proportion of ingot featuring primary silicon decreased progressively with increased Sr addition, which also markedly reduced the temperature for first formation of primary silicon and the number of primary silicon particles per unit volume �Nv: When combined with previously published results, the effects of amount of P addition and cooling rate on �Nv are in reasonable accord with �Nv� _T ¼ ðp=6fÞ1=2 109 [250 � 215 (wt pct P)0.17]�3, where �Nv is in mm�3, _T is in K/s, and f is volume fraction of primary silicon. Increased P addition reduces the eutectic temperature, while increased Sr appears to generate a minimum in eutectic temperature at about 100 ppmw Sr

Rationale and design of the hip fracture accelerated surgical treatment and care track (hip attack) trial : A protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Introduction Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial - HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. Methods and analysis HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. Ethics and dissemination All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources. Trial registration number NCT02027896; Pre-results