A retrospective study: exploring preoperative hyponatremia in elderly patients with hip fractures.

BACKGROUND: This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. METHODS: This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. RESULTS: The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. CONCLUSION: Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.

Evaluation of preoperative coagulation function changes and deep vein thrombosis incidence in elderly patients with hip fractures.

OBJECTIVE: This study involved an analysis of preoperative deep vein thrombosis (DVT) incidence and changes in coagulation function among elderly patients suffering from hip fractures. The objective was to offer guidance on the prevention and management of preoperative DVT in the lower extremities of elderly individuals with hip fractures. METHODS: A total of 282 elderly individuals with a hip fracture were enrolled and divided into two groups based on the location of the fracture: femoral intertrochanteric fracture (FIF, 161 individuals) and femoral neck fracture (FNF, 121 individuals). The two groups were compared with respect to baseline characteristics, including gender, age, and comorbid chronic diseases. Furthermore, the analysis encompassed the incidence of preoperative DVT in both lower extremities, along with seven coagulation parameters and platelet count before the surgical procedure. RESULTS: There was no significant difference in baseline information between the two groups. The incidence of preoperative DVT in the FIF group was higher than that in the FNF group, along with a significantly higher percentage of patients exhibiting increased levels of D-dimer and fibrinogen/fibrin degradation products (FDPs). CONCLUSION: Preoperative hypercoagulability and a greater prevalence of DVT were observed in elderly individuals with FIF compared to individuals with FNF. This indicates that clinicians should pay attention to elderly patients with FIFs, especially those with increased D-dimer and FDP levels.

A machine learning-based probabilistic computational framework for uncertainty quantification of actuation of clustered tensegrity structures.

Clustered tensegrity structures integrated with continuous cables are lightweight, foldable, and deployable. Thus, they can be used as flexible manipulators or soft robots. The actuation process of such soft structure has high probabilistic sensitivity. It is essential to quantify the uncertainty of actuated responses of the tensegrity structures and to modulate their deformation accurately. In this work, we propose a comprehensive data-driven computational approach to study the uncertainty quantification (UQ) and probability propagation in clustered tensegrity structures, and we have developed a surrogate optimization model to control the flexible structure deformation. An example of clustered tensegrity beam subjected to a clustered actuation is presented to demonstrate the validity of the approach and its potential application. The three main novelties of the data-driven framework are: (1) The proposed model can avoid the difficulty of convergence in nonlinear Finite Element Analysis (FEA), by two machine learning methods, the Gauss Process Regression (GPR) and Neutral Network (NN). (2) A fast real-time prediction on uncertainty propagation can be achieved by the surrogate model, and (3) Optimization of the actuated deformation comes true by using both Sequence Quadratic Programming (SQP) and Bayesian optimization methods. The results have shown that the proposed data-driven computational approach is powerful and can be extended to other UQ models or alternative optimization objectives.

A Case of Forearm Soft Tissue Infection Caused by Hypervirulent K. pneumoniae in an Otherwise Healthy 24-Year-Old Woman.

In recent years, hypervirulent Klebsiella pneumoniae (hvKp) has received greater attention. It mainly infects diabetic patients and typically causes a hepatic abscess. Here, we report a case of hvKp that caused forearm muscle and soft tissue infection in addition to bacteremia, hepatic and pulmonary abscess, and hyperglycemia. The patient's condition stabilized after comprehensive treatment. She eventually recovered and was discharged after several debridement and flap operations. At 9 months of follow-up, no signs of infectious recurrence were noted, and the hyperglycemia resolved. Here, we detail important clinical features of a severe hvKp case diagnosed in an otherwise healthy individual. This report underscores the potential of hvKp to cause deep tissue infection and present with clinical symptoms similar to gas gangrene. Symptom onset in the setting of hvKp infection is usually gradual and misdiagnosis is common. The diagnosis of hvKp should be routinely considered in the clinical setting, and be strongly suspected when presenting with characteristic epidemiological, clinical and laboratory features. Although diabetes is a predisposing factor to hvKp infection, hyperglycemia appeared to manifest as a consequence of hvKp infection in this patient.

Incidence and clinical significance of abnormalities in potassium, sodium and calcium levels in elderly patients with hip fractures during the perioperative period.

OBJECTIVE: This study aims to investigate the incidence and clinical significance of sodium, potassium and calcium electrolyte disturbances in elderly patients with hip fracture before an operation. METHODS: The clinical data of 220 patients with intertrochanteric fracture and 261 patients with femoral neck fracture from September 2013 to December 2016 in our hospital (≥60 years old) was reviewed. The sodium, potassium and calcium values, and the underlying diseases of patients were recorded after the first blood test. These patients were divided into two groups according to the fracture site: femoral neck fracture group and intertrochanteric fracture group. Then, the differences between these two groups were compared to analyze the proportion of electrolyte disturbances in elderly patients with hip fracture, and explore its clinical significance. RESULTS: Patients with intertrochanteric fractures were older than patients with femoral neck fracture. There was no significant difference in the prevalence of underlying diseases between these two groups. The incidence of hyponatremia, hypokalemia and hypocalcemia was 10.0%, 32.9% and 1.4%, respectively, in the femoral neck fracture group, and 24.3%, 21.1% and 7.7%, respectively, in the intertrochanteric fracture group. The incidence of hypernatremia, hyperkalemia and hypercalcemia was 1.4%, 1.4% and 0.9%, respectively, in the femoral neck fracture group, and 1.1%, 0.7% and 0.8%, respectively, in the intertrochanteric fracture group. CONCLUSION: Patients with old hip fractures before an operation are prone to hyponatremia, hypokalemia and hypocalcemia, and most of them have mild electrolyte disorders, which needs to be corrected in time. Furthermore, some patients urgently need urgent supplementation ofblood electrolytes for some diseases, the correction of electrolyte disorders, and the prevention of serious adverse consequences. KEY WORDS: Femoral neck fracture, Femoral intertrochanteric fracture, Hyponatremia, Hypokalemia, Hypocalcemia.

An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up.

OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.

Comparison of the Efficacy Between Two Micro-Operative Therapies of Old Patients With Osteoporotic Vertebral Compression Fracture: A Network Meta-Analysis.

Osteoporotic vertebral compression fracture (OVCF) afflicts most aged people. Except for conservative therapy (CT), percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are another two the common choices, but current evaluation of their efficacy is not performed. All the trial data were originated from electronic database including PubMed, Embase, and Cochrane Library. Four indicators with mean difference (MD) or odd ratio (OR) with their 95% credible interval (95% CrI) were analyzed to evaluate the efficacy, including the value of visual analog scale (VAS), Oswestry disability index (ODI), relieving kyphotic angle (KA), and rate of fracture. Besides, the results were demonstrated in the forest plots and slash tables. Furthermore, the surface under the cumulative ranking curve (SUCRA) was calculated. A total of 32 trials among 2,852 patients are included. Using network comparison, we found that PKP and PVP both have good performance as OVCF treatments. However, in different aspects, PKP seemed to be the best to eliminate pain with high value of SUCRA on ODI and VAS (0.624 and 0.588, respectively), and PVP had better performance in KA and decreasing incidence of fracture. The micro-operative therapy, both PKP and PVP, had better efficacy than CT in four aspects. And PKP was better in pain alleviating, according to VAS and ODI results, while PVP had the superiority in KA and reducing the incidence of fracture. J. Cell. Biochem. 118: 3205-3212, 2017. © 2017 Wiley Periodicals, Inc.

Correlation analysis of osteoporotic vertebral compression fractures and spinal sagittal imbalance.

PURPOSE: To evaluate the correlation between osteoporotic vertebral compression fractures and spinal sagittal imbalance, in order to provide a reference for clinical treatment. METHODS: From September 2013 to March 2015, 60 elderly patients with old osteoporotic vertebral compression factures (observation group) and 60 healthy elderly people (control group) were studied. Whole-spine anteroposterior and lateral view X­ray photographs were taken from all participants, the number and location of fractured vertebrae were recorded, and sagittal parameters in both groups were compared. The observation group was divided into three subgroups according to the number of fractured vertebrae. The C7/sacrofemoral distance (SFD) ratio in the three subgroups was compared, and the correlation between the number of fractured vertebrae and the C7/SFD ratio was analyzed. RESULTS: The thoracic kyphotic angle in patients in the observation group was higher than in the control group (P < 0.05), the lumbar lordotic angle in patients in the observation group was lower than in the control group (P < 0.05), the absolute value of the T1 spinopelvic inclination angle in patients in the observation group was lower than in the control group (P < 0.05), and the C7/SFD ratio of patients in the observation group was higher than in the control group (P < 0.05). C7/SFD ratios of the subgroups differed from each other, and the number of fractured vertebrae and C7/SFD ratio were positively correlated. CONCLUSION: Osteoporotic vertebral compression fractures can change local spinal sagittal alignment, multiple vertebral compression fractures can cause spinal sagittal imbalance, and the number of fractured vertebrae and the degree of forward movement of the spine were positively correlated.

[AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE].

OBJECTIVE: To investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. METHODS: Between February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. RESULTS: All incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. CONCLUSIONS: Anterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.

[Characterization of a mariner transposon pKKma].

OBJECTIVE: This study was aimed at sequence analysis and function annotation of plasmid pKKma carrying a mariner transposon. METHODS: Primers were designed based on the partial known sequence and used for directly sequencing plasmid pKKma. Transposon mutagenesis libraries were constructed to analyze the mutagenesis efficiency of plasmid pKKma. RESULTS: pKKma comprises 6879 bp with 7 open reading frames (ORFs). Among them, ORF6 encodes a mariner transposase of 348 amino acids (aa), a C9 variant of Himar1 type transposase. Two inverted terminal repeats (ITRs) are identified and of 27 bp each. ORF7 encodes gentamycin resistance gene aacC1, locating between two ITRs. Transposable sequence alignment with other mariner transposons shows that the coverage is 2.0% -47.7% and the homology is 3.2% to 99.7%. The result indicates pKKma is significantly different from the other vectors with mariner transposon. The transposition efficiency is also analyzed. It's (3.1 x 10(-4)) - (4.8 x 10(-4)) for S. marcascens and (1.3 x 10(-3)) - (1.7 x 10(-3)) for C. freundii, respectively. CONCLUSION: pKKma carries a new mariner transposon and could be used to study the role of genes by constructing transposon libraries in bacteria.

Characterization of acetoin production in a budC gene disrupted mutant of Serratia marcescens G12.

The 2,3-butanediol (2,3-BD) dehydrogenase gene budC of Serratia marcescens G12 was disrupted to construct the acetoin (AC) producing strain G12M. In shake-flask cultures, AC production was enhanced by increased concentrations of glucose or sodium acetate in G12M. In fed-batch fermentation, G12M produced 47.5 g/L AC along with 9.8 g/L 2,3-BD. The expression of the key enzymes for AC synthesis was further investigated. Alpha-acetolactate synthase gene budB decreased its expression significantly in G12M compared with G12. This probably explained the moderate AC production in G12M cultures. Additionally, overexpression of budB gene and α-acetolactate decarboxylase gene budA was conducted in G12M and no significant increase of AC was observed. The results suggested that intracellular AC accumulation might inhibit the expression of budB and budA gene and induce budC gene expression in G12M. Our analyses offered the bases for further genetic manipulations in improving AC production in microbial fermentations.

Microbial production of 2,3-butanediol by a newly-isolated strain of Serratia marcescens.

A newly-isolated strain of Serratia marcescens, G12, was characterized for 2,3-butanediol (2,3-BD) production. In shake-flask and batch fermentations, 2,3-BD reached 48.5 and 51 g l(-1), respectively. Low amounts of (~8 g l(-1)) of acetoin were also formed. In fed-batch fermentations, strain G12 produced 72.8 g 2,3-BD l(-1) with glucose initially at 130 g l(-1). When aeration rate was increased to 2.5 vvm for the fermentation process, 2,3-BD reached 87.8 g l(-1) and the highest productivity was 1.6 g l(-1 )h(-1). Acetoin was at 6.2 g l(-1). G12 therefore may be a suitable candidate strain for large-scale production of 2,3-BD.