A Real-world Study of Denosumab For Reducing Refracture Risk after Percutaneous Vertebral Augmentation.

OBJECTIVE: To investigate the use of anti-osteoporotic agents and refracture incidence in patients with osteoporotic vertebral compression fracture (OVCF) following percutaneous vertebral augmentation (PVA) and to evaluate the real-world treatment of patients using denosumab following PVA. This study aims to provide spine surgeons with empirical insights derived from real-world scenarios to enhance the management of bone health in OVCF patients. METHODS: This retrospective cohort study was based on data from the MarketScan and Optum databases from the USA. Female patients aged 55-90 years who underwent PVA for OVCF between January 2013 and March 2020 were included and followed up from the day after surgery. Patients who received at least one dose of denosumab were included in the denosumab cohort and were further divided into the on-treatment and off-treatment groups according to whether they received a second dose of denosumab, with follow-up beginning on the index day (225 days after the first denosumab dose). In this study, the off-treatment group was considered as the control group. Refracture incidence after PVA, the proportion of patients using anti-osteoporotic agents in the total study population, and refracture incidence after the index day in the denosumab cohort were analyzed. RESULTS: A total of 13,451 and 21,420 patients from the MarketScan and Optum databases, respectively, were included. In the denosumab cohort, the cumulative incidence of clinical osteoporotic fractures within 3 years after the index day was significantly lower in the on-treatment group than in the off-treatment group (MarketScan database: 23.0% vs 39.0%, p = 0.002; Optum database: 28.2% vs 40.0%, p = 0.023). The cumulative incidence of clinical vertebral fractures was also lower in the on-treatment group than in the off-treatment group, with a significant difference in the MarketScan database (14.4% vs 25.5%, p = 0.002) and a numerical difference was found in the Optum database (20.2% vs 27.5%, p = 0.084).The proportion of patients using anti-osteoporotic agents was low at 6 months postoperatively, with only approximately 7% using denosumab and 13%-15% taking oral bisphosphonates. CONCLUSION: Postmenopausal women have a high refracture rate and a low proportion of anti-osteoporotic drug use after PVA. Continued denosumab treatment after PVA is associated with a lower risk of osteoporotic and clinical vertebral fractures. Therefore, denosumab may be a treatment option for patients with osteoporosis after PVA.

The comparative studies on the magnetic relaxation behaviour of the axially-elongated pentagonal-bipyramidal dysprosium and erbium ions in similar one-dimensional chain structures.

A family of cyano-bridged 3d-4f 1D chain compounds, {RE[TM(CN)6(2-PNO)5]}·(H2O)4 {RE = YIII, TM = [FeIII]LS (1); RE = DyIII, TM = CoIII (3); RE = ErIII, TM = [FeIII]LS (4), CoIII (5); 2-PNO = 2-picoline-N-oxide} and {RE[TM(CN)6(2-PNO)5]} {RE = DyIII, TM = [FeIII]LS (2)}, were synthesized and characterized. Single-crystal X-ray diffraction studies reveal that compounds 1 and 3-5 are isostructural, while compound 2 has a similar 1D chain structure with a different chain to chain arrangement. An axially-elongated pentagonal bipyramidal (D5h) coordination geometry is formed with five 2-PNO ligands in the equatorial plane and two [TM(CN)6]3- on the apical sites around the rare earth ions in these compounds. A comparison of the magnetic relaxation behaviour in detail reveals that it is more favorable for the Er (4 and 5) than the Dy analogues (2 and 3) to exhibit SIM properties in this axially-elongated D5h coordination environment. Under zero dc field, ac susceptibility measurements show that the Dy analogues have no magnetic relaxation behaviour, while the Er analogues exhibit frequency dependence despite the strong QTM effect. Under a 1 kOe dc field, the Er analogues generally show 1-2 orders of magnitude longer relaxation time at each selected temperature and a higher relaxation energy barrier than the Dy analogues. And the RECo compounds (3 and 5) show a more suppressed QTM effect than the corresponding REFe (2 and 4) compounds, which may be ascribed to the elimination of the fluctuation field from the neighbouring [FeIII]LS ions. The ab initio calculations indicate the misplacement between the orientation of the main magnetic axis and the structural axis in the Dy analogues, and the relative consistency in the Er analogues, which should be the source of the Er analogues showing better SIM properties than the Dy analogues.

Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective.

The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4-0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4-0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4-0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6-0.9), shorter length of hospitalization (VB vs OF: ß: -0.4, P < .001; NVB vs OF: ß: -0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97-1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7-1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.

Occupational injury surveillance pyramid description and association of medical care utilization with low income among work-related injuries.

BACKGROUND: A more comprehensive characterization of total work-related injury burden would ideally include all levels of medical care. Additionally, studies have suggested differential utilization of medical care among various socioeconomic groups, and it is unclear how this translates to work-related injuries. METHODS: The 2004-2016 National Health Interview Survey data were used to estimate all levels of care utilized by the individual for each injury episode. A multivariable logistic regression model based on 2004-2014 data was developed to investigate the relationship of low income and level of medical care used by the injured worker. RESULTS: Around 53.1% of occupational injury were exclusively treated outside of a hospital setting and never captured by hospital/emergency department data systems, which comprises 40% (3.0 million) of total missed days of work and 44% ($452 million) of total cost of lost productivity among full-time workers. Patients with work-related injuries are less likely to stay overnight in hospital compared with those with nonwork-related injuries (adjusted odds ration [aOR]: 0.6, 95% confidence interval [CI]: 0.5-0.7), however among work-related injuries, low-income patients are more likely to use medical care in a hospital setting compared with patients with income higher than poverty threshold (hospitalization: aOR: 1.9, 95% CI: 1.1-3.3; emergency room: aOR: 1.5, 95% CI: 1.1-2.0). CONCLUSIONS: These "minor work-related injuries" exclusively treated outside hospital tend to be ignored when defining national injury prevention priorities, but this analysis indicates that such an approach fails to capture a large portion of injuries significant enough to result in missed days of work and cost of lost productivity.

In Situ Integration of Ultrathin PtCu Nanowires with Reduced Graphene Oxide Nanosheets for Efficient Electrocatalytic Oxygen Reduction.

Ultrathin Pt-based nanowires are considered as promising electrocatalysts owing to their high atomic utilization efficiency and structural robustness. Moreover, integration of Pt-based nanowires with graphene oxide (GO) could further increase the electrocatalytic performance, yet remains challenging to date. Herein, for the first time we demonstrate the in situ synthesis of ultrathin PtCu nanowires grown over reduced GO (PtCu-NWs/rGO) by a one-pot hydrothermal approach with the aid of amine-terminated poly(N-isopropyl acrylamide) (PNIPAM-NH2 ). The judicious selection of PNIPAM-NH2 facilitates the in situ nucleation and anisotropic growth of nanowires on the rGO surface and oriented attachment mechanism accounts for the formation of PtCu ultrathin nanowires. Owing to the synergy between PtCu NWs and rGO support, the PtCu-NWs/rGO outperforms the rGO supported PtCu nanoparticles (PtCu-NPs/rGO), PtCu-NWs, and commercial Pt/C toward the oxygen reduction reaction (ORR) with higher activity and better stability, making it a promising cathodic electrocatalyst for both fuel cells and metal-air cells. Moreover, the present synthetic strategy could inspire the future design of other metal alloy nanowires/carbon hybrid catalysts.

Work-Related Burn Injuries Hospitalized in US Burn Centers: 2002 to 2011.

OBJECTIVE: To develop a comprehensive definition to identify work-related burns in the National Burn Repository (NBR) based on multiple fields and describes injuries by occupation. METHODS: The NBR, which is an inpatient dataset, was used to compare type and severity of burn injuries by occupation. RESULTS: Using the definition developed for this analysis, 22,969 burn injuries were identified as work-related. In contrast, the single work-related field intended to capture occupational injuries only captured 4696 cases. The highest numbers of burns were observed in construction/extraction, food preparation, and durable goods production occupations. Occupations with a mean total body surface area (TBSA) burned greater than 10% include transportation and material-moving, architecture and engineering, and arts/design/entertainment/sports/media occupations. CONCLUSIONS: The NBR dataset should be further utilized for occupational burn injury investigations and multiple fields should be considered for case ascertainment.