[HIP FRACTURE SURGERY DELAY IN PATIENTS TREATED WITH ORAL ANTICOAGULANTS: RESULTS FROM SHEBA MEDICAL CENTER].

BACKGROUND: Hip fractures (HF) are a major cause of morbidity and mortality in the elderly population. Many factors are associated with HF post-operative prognosis, among them the admission to operation time (AOT) is a major factor. Delayed surgery (> 48 hours) is associated with increased morbidity and mortality. The use of anti-coagulants (OAC) often leads to surgery delay to prevent possible surgical bleeding. OBJECTIVES: To test the association between the use of OAC and AOT. METHODS: The study was a retrospective cohort of consecutive patients above 65 years of age admitted and operated for hip fracture at the Sheba Medical Center between the years 2014-2018. We compared AOT between OAC treated and non-treated patients. We conducted multi-variable analysis to examine the effect of OAC on AOT. RESULTS: Overall, 1013 case patients were studied, among them 151 were treated with OAC (research group) and 865 patients without any anti-coagulation treatment (control group). Surgery delay over 48 hours was observed in 24.6% OAC treated patients compared to 12% in the non-treatment group (p=0.0001). Median AOT was 32 hours compared to 24.6 hours in treated vs non-treated patients, respectively, p=0.0001. Apixaban is the only drug found not to prolong AOT. In multivariate analysis OAC therapy was the only significant cause for surgical delay. CONCLUSIONS: Patients with HF treated with anti-coagulants are experiencing delayed surgery compared to non-treated patients.

Should it really be called a heroic cerclage? The obstetrical results of emergency late second-trimester cerclage compared with early history-indicated elective cerclage: a retrospective trial.

PURPOSE: Women diagnosed with mid-trimester cervical insufficiency and dilatation are offered interventions to salvage and support the cervix, where the mainstay of therapy is emergency cervical cerclage. However, considering the significant morbidity associated with delivery in the extreme prematurity period, some women may opt for pregnancy termination. In addition, it is expected that elective cerclage in a subsequent pregnancy may yield better obstetrical results. The objective of this study was, therefore, to compare the obstetrical outcomes of emergency cerclage versus elective cerclage. METHODS: This is a retrospective cohort study of the pregnancy outcomes of women with a singleton pregnancy who underwent cervical cerclage at our institution between December 2008 and November 2021. Women who underwent emergency cervical cerclage due to painless dilatation in the second trimester were compared with women who underwent elective cerclage. RESULTS: Overall, 32 women who underwent emergency cerclage and 183 women who underwent elective cerclage were included. No cases of iatrogenic membrane rupture were noted during the cerclage procedure. There was no statistical difference between the emergency cerclage group and the elective cerclage group in the primary outcomes: gestational age at delivery (35.8 + 4.7 vs 36.3 + 4.9, p = 0.58, respectively), delivery in the extreme prematurity period (between 24 and 28 gestational weeks, 6.5% vs 2.3%, p = 0.21, respectively), and fetal or neonatal death (6.9% vs 6.3%, p = 0.91, respectively). CONCLUSION: Although there are much less favourable circumstances, emergency cerclage is a safe procedure with comparable obstetrical outcomes to elective cerclage. Patient selection and experienced medical team may play a significant role in those cases.

Growth model interpretation of planet size distribution.

The radii and orbital periods of 4,000+ confirmed/candidate exoplanets have been precisely measured by the Kepler mission. The radii show a bimodal distribution, with two peaks corresponding to smaller planets (likely rocky) and larger intermediate-size planets, respectively. While only the masses of the planets orbiting the brightest stars can be determined by ground-based spectroscopic observations, these observations allow calculation of their average densities placing constraints on the bulk compositions and internal structures. However, an important question about the composition of planets ranging from 2 to 4 Earth radii (R⊕) still remains. They may either have a rocky core enveloped in a H2-He gaseous envelope (gas dwarfs) or contain a significant amount of multicomponent, H2O-dominated ices/fluids (water worlds). Planets in the mass range of 10-15 M⊕, if half-ice and half-rock by mass, have radii of 2.5 R⊕, which exactly match the second peak of the exoplanet radius bimodal distribution. Any planet in the 2- to 4-R⊕ range requires a gas envelope of at most a few mass percentage points, regardless of the core composition. To resolve the ambiguity of internal compositions, we use a growth model and conduct Monte Carlo simulations to demonstrate that many intermediate-size planets are "water worlds."