ABSTRACT
PURPOSE: To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture. METHODS: All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out. RESULTS: Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis. CONCLUSIONS: One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.
Subject(s)
Aging , Analgesics, Opioid/adverse effects , Bone Density Conservation Agents/adverse effects , Hip Fractures/physiopathology , Osteoporosis/drug therapy , Osteoporotic Fractures/physiopathology , Pain/prevention & control , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , Bone Density Conservation Agents/therapeutic use , Cognition Disorders/complications , Cognition Disorders/physiopathology , Female , Hip Fractures/complications , Hip Fractures/rehabilitation , Hip Fractures/therapy , Home Care Services , Hospital Mortality , Hospitals, Urban , Humans , Longitudinal Studies , Male , Mortality , Osteoporosis/physiopathology , Osteoporotic Fractures/complications , Osteoporotic Fractures/rehabilitation , Osteoporotic Fractures/therapy , Pain/drug therapy , Pain/etiology , Severity of Illness Index , Sex Characteristics , Spain/epidemiology , Survival AnalysisABSTRACT
The differentiation and organization of the embryonic renal vasculature is a crucial event in renal development. To study this process, we developed a serum-free in vitro model of renal microvessel development. Mouse embryonic kidney explants, when embedded specifically in type I collagen, demonstrate outgrowth of microvascular structures when stimulated by the phorbol ester 12-O-tetradecanoylphorbol 13-acetate (TPA, 10-50 ng/ml). Other polypeptide growth factors stimulated little, if any, microvessel outgrowth from the explants. Similar outgrowths were not observed when other embryonic tissue explants were used. The number of microvessels observed depended on the gestational age of the explants. We hypothesize that TPA induces the in situ differentiation of metanephric mesenchymal cells into endothelial cell precursors and that specific matrix proteins and cell-matrix interactions are necessary for the organization of these precursors into microvessels. Our model will allow us to examine in detail the responsiveness of metanephric kidney cells to both growth factors and extracellular matrix molecules and to understand how they influence renal endothelial cell differentiation.
