The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

Progression of coronary artery calcification in conventional hemodialysis, nocturnal hemodialysis, and kidney transplantation

Introduction Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients. Methods We measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (>= 4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (Delta CAC SQRV) using linear mixed models. Reference category was conventional hemodialysis. Results The mean age of the study population was 53 +/- 13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12-56) months. Median CAC score at enrollment was 171 (IQR 10-647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models. Conclusions Nocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

ObjectivesTo assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks.Subjects/patients and methodsA randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO2AT) following HIIT vs. standard care.ResultsForty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO2AT; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25–3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: −8.2 mmHg (95% CI −16.09 to −0.29) and DBP: −6.47 mmHg (95% CI −12.56 to −0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%.ConclusionsHIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable pre-operative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socio-economic impact and long-term survival

A double-blind placebo controlled trial into the impacts of HMB supplementation and exercise on free-living muscle protein synthesis, muscle mass and function, in older adults

Age-related sarcopenia and dynapenia are associated with frailty and metabolic diseases. Resistance exercise training (RET) adjuvant to evidence-based nutritional intervention(s) have been shown as mitigating strategies. Given that \u3b2-hydroxy-\u3b2-methyl-butyrate (HMB) supplementation during RET improves lean body mass in younger humans, and that we have shown that HMB acutely stimulates muscle protein synthesis (MPS) and inhibits breakdown; we hypothesized that chronic supplementation of HMB free acid (HMB-FA) would enhance MPS and muscle mass/function in response to RET in older people. We recruited 16 healthy older men (Placebo (PLA): 68.5 \ub1 1.0 y, HMB-FA: 67.8 \ub1 1.15 y) for a randomised double-blind-placebo controlled trial (HMB-FA 3 7 1 g/day vs. PLA) involving a 6-week unilateral progressive RET regime (6 7 8 repetitions, 75% 1-RM, 3 \ub7 wk 121). Deuterium oxide (D2O) dosing was performed over the first two weeks (0\u20132 wk) and last two weeks (4\u20136 wk) with bilateral vastus lateralis (VL) biopsies at 0\u20132 and 4\u20136 wk (each time 75 \ub1 2 min after a single bout of resistance exercise (RE)) for quantification of early and later MPS responses and post-RE myogenic gene expression. Thigh lean mass (TLM) was measured by DXA, VL thickness and architecture (fibre length and pennation angle) by ultrasound at 0/3/6 wk, and strength by knee extensor 1-RM testing and MVC by isokinetic dynamometry (approx. every 10 days). RET induced strength increases (1-RM) in the exercised leg of both groups (398 \ub1 22N to 499 \ub1 30N HMB-FA vs. 396 \ub1 29N to 510 \ub1 43N PLA (both P < 0.05)). In addition, maximal voluntary contraction (MVC) also increased (179 \ub1 12 Nm to 203 \ub1 12 Nm HMB-FA vs. 185 \ub1 10 Nm to 217 \ub1 11 Nm PLA (both P < 0.05); with no group differences. VL muscle thickness increased significantly in the exercised leg in both groups, with no group differences. TLM (by DXA) rose to significance only in the HMB-FA group (by 5.8%\u20135734 \ub1 245 g p = 0.015 vs. 3.0% to 5644 \ub1 323 g P = 0.06 in PLA). MPS remained unchanged in the untrained legs (UT) 0\u20132 weeks being 1.06 \ub1 0.08%.d 121 (HMB-FA) and 1.14 \ub1 0.09%.d 121 (PLA), the trained legs (T) exhibited increased MPS in the HMB-FA group only at 0\u20132-weeks (1.39 \ub1 0.10%.d 121, P < 0.05) compared with UT: but was not different at 4\u20136-weeks: 1.26 \ub1 0.05%.d 121. However, there were no significant differences in MPS between the HMB-FA and PLA groups at any given time point and no significant treatment interaction observed. We also observed significant inductions of c-Myc gene expression following each acute RE bout, with no group differences. Further, there were no changes in any other muscle atrophy/hypertrophy or myogenic transcription factor genes we measured. RET with adjuvant HMB-FA supplements in free-living healthy older men did not enhance muscle strength or mass greater than that of RET alone (PLA). That said, only HMB-FA increased TLM, supported by early increases in chronic MPS. As such, chronic HMB-FA supplementation may result in long term benefits in older males, however longer and larger studies may be needed to fully determine the potential effects of HMB-FA supplementation; translating to any functional benefit

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Background: Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis. Methods: We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (CAC SQRV) and with Tobit mixed models. We adjusted for potential confounders. Results: In the cross-sectional cohort, CAC volume scores were 92 mm(3) in hemodialysis and 492 mm(3) in peritoneal dialysis (adjusted difference 436 mm(3); 95% CI -47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as CAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm(3); 95% CI -140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A. Conclusions: Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis

Is cultured meat a promising consumer alternative? Exploring key factors determining consumer's willingness to try, buy and pay a premium for cultured meat

Cultured meat is a relatively new product, enjoying consumer appreciation as a more sustainable meat option. The present study builds on a sample from a diverse set of countries and continents, including China, the US, the UK, France, Spain, Netherlands, New Zealand, Brazil, and the Dominican Republic and uses partial least square structural equation modelling. The proposed conceptual model identified key factors driving and inhibiting consumer willingness to try, buy, and pay a price premium for cultured meat. Results relate to the overall sample of 3091 respondents and two sub-sample comparisons based on gender and meat consumption behaviour. Food neophobia, having food allergies, being a locavore, and having concerns about food technology were found to be inhibiting factors towards willingness to try, buy, and pay a price premium for cultured meat. Food curiosity, meat importance, and a consumer's perception of cultured meat as a realistic alternative to regular meat were found to be important drivers that positively impacted consumers' willingness to try, buy and pay more. Best practice recommendations address issues facing marketing managers in food retail and gastronomy

A double-blind placebo controlled trial into the impacts of HMB supplementation and exercise on free-living muscle protein synthesis, muscle mass and function, in older adults

Age-related sarcopenia and dynapenia are associated with frailty and metabolic diseases. Resistance exercise training (RET) adjuvant to evidence-based nutritional intervention(s) have been shown as mitigating strategies. Given that HMB supplementation during RET improves lean body mass in younger humans (Wilson et al., 2014), and that we have shown that HMB acutely stimulates muscle protein synthesis (MPS) and inhibits breakdown; we hypothesized that chronic supplementation of HMB adjuvant to RET would enhance MPS and muscle mass/function in older people.We recruited 16 healthy older men (PLA: 68.5±1.0y, HMB: 67.8±1.1y) for a randomised double-blind-placebo (PLA) controlled trial (HMB 3 x 1g/day vs. PLA) involving a 6-week unilateral progressive RET regime (6 x 8 repetitions, 75% 1-RM, 3.wk-1). D2O dosing was performed over the first two weeks (0-2w) and last two weeks (4-6w) with bilateral vastus lateralis (VL) biopsies at 0-2 and 4-6 weeks (each time 75±2 min after a single bout of RE) for quantification of early and later MPS responses and post-RE myogenic gene expression. Thigh lean mass was measured by DXA, VL thickness and architecture (fibre length and pennation angle) by ultrasound at 0/3/6 weeks, and strength by knee extensor 1-RM testing and MVC by isokinetic dynamometry (approx. every 10 days).RET induced strength increases (1-RM) in the exercised leg in both groups (398±22N to 499±30N HMB vs. 396±29N to 510±43N PLA (both

Prevalence of osteoporosis and incidence of hip fracture in women - secular trends over 30 years

<p>Abstract</p> <p>Background</p> <p>The number of hip fractures during recent decades has been reported to be increasing, partly because of an increasing proportion of elderly women in the society. However, whether changes in hip fracture annual incidence in women are attributable to secular changes in the prevalence of osteoporosis is unclear.</p> <p>Methods</p> <p>Bone mineral density was evaluated by single-photon absorptiometry at the distal radius in 456 women aged 50 years or above and living in the same city. The measurements were obtained by the same densitometer during three separate time periods: 1970-74 (n = 106), 1987-93 (n = 175) and 1998-1999 (n = 178), and the age-adjusted prevalence of osteoporosis in these three cohorts was calculated. Additionally, all hip fractures sustained in the target population of women aged 50 years or above between 1967 and 2001 were registered, whereupon the crude and the age-adjusted annual incidence of hip fractures were calculated.</p> <p>Results</p> <p>There was no significant difference in the age-adjusted prevalence of osteoporosis when the three cohorts were compared (P = 1.00). The crude annual incidence (per 10,000 women) of hip fracture in the target population increased by 110% from 40 in 1967 to 84 in 2001. The overall trend in the crude incidence between 1967 and 2001 was increasing (1.58 per 10,000 women per year; 95 percent confidence interval, 1.17 to 1.99), whereas the age-adjusted incidence was stable over the same period (0.22 per 10,000 women per year; 95 percent confidence interval, -0.16 to 0.60).</p> <p>Conclusions</p> <p>The increased number of hip fracture in elderly women is more likely to be attributable to demographic changes in the population than to secular increase in the prevalence of osteoporosis.</p

Understanding key factors influencing consumers’ willingness to try, buy, and pay a price premium for mycoproteins

Mycoprotein is a fungal-based meat alternative sold in food retail in various countries around the world. The present study builds on a multi-national sample and uses partial least square structural equation modeling. The proposed conceptual model identified key factors that are driving and inhibiting consumer willingness to try, buy, and pay a price premium for mycoprotein. The results relate to the overall sample of 4088 respondents and to two subsample comparisons based on gender and meat consumption behavior. The results show that the biggest drivers of willingness to consume mycoprotein were healthiness, followed by nutritional benefits, safe to eat, and sustainability. Affordability and taste had mixed results. Willingness to consume mycoprotein was inhibited if nutritional importance was placed on meat and, to a lesser extent, if the taste, texture, and smell of meat were deemed important. Best practice recommendations address issues facing marketing managers in the food industry