Effects of Fracture Liaison Service on Outcomes of Patients with Hip Fracture in Rural Area of an Asian Country.

Introduction: Fracture Liaison Services (FLS) has been proven effective in reducing subsequent fractures and related mortality. However, more research is needed on the impact of FLS on the 30-day readmission rate and its effectiveness in rural hospitals. This study aims to assess the impact of FLS on clinical outcomes including readmission rates, subsequent fractures, and fracture-related mortality in rural areas of an Asain country. Materials and methods: In a rural hospital in Taiwan, we conducted a two-year prospective cohort study on elderly individuals with fragility hip fractures. The study compared the clinical outcomes between the control group and the FLS-cohort group. Logistic regression analysis was used to identify factors contributing to 1-year mortality after injury. Results: 556 patients were enrolled. (304 in the control group and 252 in the FLS group) The mean age was 79.8 years. The findings revealed that the introduction of FLS did not result in significant differences in mortality, readmission, complication, subsequent fractures, or secondary hip fractures. However, there were notable improvements in the length of hospital stay and the proportion of patients receiving surgery within 48 h following the implementation of FLS. Subgroup analysis showed that FLS patients who received anti-osteoporotic treatment had lower mortality and 30-day readmission rates. Factors associated with higher 1-year mortality included male, high ASA level, and delayed surgery. Discussion: This study provides the real-life evidence of the effect of intensive FLS model in a rural hospital in an Asian country. Conclusion: While FLS did not show significant differences in certain clinical outcomes, it led to shorter hospital stays and increased timely surgeries. FLS patients receiving anti-osteoporotic treatment had better mortality and readmission rates. Further research is necessary to gain a comprehensive understanding of the impact of FLS care in rural areas of Asia.

6-methoxyflavone suppresses neuroinflammation in lipopolysaccharide- stimulated microglia through the inhibition of TLR4/MyD88/p38 MAPK/NF-κB dependent pathways and the activation of HO-1/NQO-1 signaling.

BACKGROUND: Microglia-related neuroinflammation is associated with a variety of neurodegenerative diseases. Flavonoids have demonstrated different pharmacological effects, such as antioxidation, neuroprotection and anti-inflammation However, the effect of flavonoid 6-methoxyflavone (6-MeOF) on microglia-mediated neuroinflammation remain unknown. PURPOSE: The current study aim to study the antineuroinflammatory effects of 6-MeOF in lipopolysaccharide- (LPS-) induced microglia in vitro and in vivo. METHODS: Pretreatment of BV2 microglia cells with 6-MeOF for 1 h then stimulated with LPS (100 ng/ml) for 24 h. The expression levels of pro-inflammatory factors, NO and reactive oxygen species (ROS) were performed by the enzyme-linked immunosorbent assay (ELISA), Griess assay and flow cytometry. Western blotting was used to assess MAPK, NF-κB signal transducer and antioxidant enzymes-related proteins. Analysis of ROS and microglial morphology was confirmed in the zebrafish and mice brain, respectively. RESULTS: Our results demonstrated that 6-MeOF dose-dependently prevent cell death and decreased the levels of pro-inflammatory mediators in LPS-stimulated BV2 microglia cells. Phosphorylated NF-κB/IκB and TLR4/MyD88/p38 MAPK/JNK proteins after exposure to 6-MeOF was suppressed in LPS-activated BV-2 microglial cells. 6-MeOF also presented antioxidant activity by reduction of NO, ROS, iNOS and COX-2 and the induction of the level of HO-1 and NQO1 expressions in LPS-activated BV2 microglial cells. Furthermore, we demonstrated that 6-MeOF inhibited LPS-induced NO generation in an experimental zebrafish model and prevent the LPS-induced microgliosis in the prefrontal cortex and substantia nigra of mice. CONCLUSION: These results explored that 6-MeOF possesses potential as anti-inflammatory and anti-oxidant agents against microglia-associated neuroinflammatory disorders.

Mechanical Comparison of a Novel Hybrid and Commercial Dorsal Double Plating for Distal Radius Fracture: In Vitro Fatigue Four-Point Bending and Biomechanical Testing.

This study compares the absolute and relative stabilities of a novel hybrid dorsal double plating (HDDP) to the often-used dorsal double plating (DDP) under distal radius fracture. The "Y" shape profile with 1.6 mm HDDP thickness was obtained by combining weighted topology optimization and finite element (FE) analysis and fabricated using Ti6Al4V alloy to perform the experimental tests. Static and fatigue four-point bending testing for HDDP and straight L-plate DDP was carried out to obtain the corresponding proof load, strength, and stiffness and the endurance limit (passed at 1 × 106 load cycles) based on the ASTM F382 testing protocol. Biomechanical fatigue tests were performed for HDDP and commercial DDP systems fixed on the composite Sawbone under physiological loads with axial loading, bending, and torsion to understand the relative stability in a standardized AO OTA 2R3A3.1 fracture model. The static four-point bending results showed that the corresponding average proof load values for HDDP and DDPs were 109.22 N and 47.36 N, that the bending strengths were 1911.29 N/mm and 1183.93 N/mm, and that the bending stiffnesses were 42.85 N/mm and 4.85 N/mm, respectively. The proof load, bending strength and bending stiffness of the HDDPs were all significantly higher than those of DDPs. The HDDP failure patterns were found around the fourth locking screw hole from the proximal site, while slight plate bending deformations without breaks were found for DDP. The endurance limit was 76.50 N (equal to torque 1338.75 N/mm) for HDDP and 37.89 N (equal to torque 947.20 N/mm) for DDP. The biomechanical fatigue test indicated that displacements under axial load, bending, and torsion showed no significant differences between the HDDP and DDP groups. This study concluded that the mechanical strength and endurance limit of the HDDP was superior to a commercial DDP straight plate in the four-point bending test. The stabilities on the artificial radius fractured system were equivalent for novel HDDP and commercial DDP under physiological loads in biomechanical fatigue tests.

Biomechanical investigation of a novel hybrid dorsal double plating for distal radius fractures by integrating topology optimization and finite element analysis.

BACKGROUND: Currently available dorsal locking plates for the treatment of distal radius fractures are far less then volar locking plates, and there is limited evidence about biomechanical strength of dorsal plates. The aim of this study is to develop a novel hybrid dorsal double plating, which enhance biomechanical strength in the articular fixation region and achieve the minimally invasive surgical technique requirement of distal radius fracture treatment by combining weighted topology optimization and finite element (FE) analysis METHODS: A dorsal template bone plate design (based on dorsal double plating (DDP)) was constructed to perform weighted topology optimization and FE analysis under six fracture models with 50%, 30%, and 20% weighting of the joint subjected to axial, bending, and torsion moments, respectively. A novel hybrid dorsal double plating (HDDP) was generated using the union of six single dorsal plates to subtract the intersection of the original template dorsal model. A 100 N axial load with 1 Nm bending and torsion moments were applied at the end of the distal radius onto six fracture FE models to investigate the biomechanical differences between the DDP and HDDP approaches. RESULTS: Results of weighted topology optimization showed that the profile of the HDDP presented a "Y" shape. Simulation results showed that the bone plate stress values for the distal radius fractures fixed with HDDP was much smaller than those with DDP regardless of the type of bone fractures and load conditions. The maximum bone stress value of the DDP approach was much higher than that of HDDP when the distal radius was a complete sagittal articular fracture and partial articular fracture involving lunate fossa. The corresponding maximum bone stress values for different loads might be higher than the ultimate strength of bone (150  MPa) and induced the risk of future bone fractures. CONCLUSIONS: It is concluded that the novel HDDP demonstrated better resistance to functional loads, provided sufficient screw fixation at the articular surface, and can be placed on the dorsal site of the distal radius through the standard dorsal approach to minimize invasive surgeries and eliminate tendon irritations.

Short-term outcomes of hip fractures in patients aged 90 years old and over receiving surgical intervention.

BACKGROUND: The knowledge about short-term outcomes of nonagenarians undergoing surgery for hip fracture in Asian is limited. METHODS: The patients with hip fractures who underwent hip hemiarthroplasty and open reduction with internal fixation (ORIF) for management during the period from 2008 to 2012 were identified and their medical record was retrospectively reviewed. RESULTS: During the study period, a total of 101 patients underwent surgery for management of hip fractures, and the age of patients ranged from 90 to 96 years. The sites of hip fracture were intertrochanteric (n = 57, 56.4%) and the neck of the femur (n = 44, 43.6%). Most of the patients had American Society of Anesthesiologists scores of 3(n = 55) or 4 (in 44 patients). 80.2% (n = 81) underwent the operation within one day after admission; however, there were 13 patients (12.9%) that underwent surgery 48 or more hours later. ORIF and hemiarthroplasty were performed for 63 (62.4%) and 38 (37.6%) patients, respectively. Overall, the 30-day and 1-year mortality rates were 9.9% (10/101) and 17.3% (13/75), respectively. Multivariate analysis showed that the 30-day mortality was significantly associated only with end-stage renal disease (ESRD) (Odds ratio, 11.13, 95% confidence interval, 1.275-97.881, P = .029). CONCLUSIONS: The short-term outcome of surgical management for Asian nonagenarians with hip fractures is favorable in selected patients.