120-day Follow-up Research Articles

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

PurposeTo determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients.MethodsData from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points.ResultsPatients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74).ConclusionTreatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures-Results from the Registry for Geriatric Trauma of the German Trauma Society.

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

Associations Between Sputum Torque Teno Virus Load and Lung Function and Disease Severity in Patients With Chronic Obstructive Pulmonary Disease

Purpose: Viral load of Torque Teno virus (TTV) is elevated in immunosuppressed patients. The weakened immune response is typical in chronic obstructive pulmonary disease (COPD) patients. However, the relationship between TTV and COPD is still unknown.Patients and Methods: We enrolled 91 patients admitted to hospitals with acute exacerbation of COPD (AECOPD) between January 2017 and August 2017 (ClinicalTrials.gov ID, NCT03236480). Sputum samples were gathered during hospitalization and the 120-day follow-up. TTV distribution and genogroups were assessed, and the associations between viral loads and clinical parameters were analyzed.Results: TTV DNA was detected in 95.6% of COPD patients, and the viral load was nearly invariable at the stable and exacerbation states. Most TTV DNA-positive patients carried four distinct genotypes. Sputum load of TTV was positively associated with RV/TLC (r = 0.378, p = 0.030), and negatively correlated with FEV1/pre and FEV1/FVC (r = −0.484, −0.432, p = 0.011, 0.024, respectively). Neutral correlation between the TTV DNA load and COPD assessment test (CAT) scores (r = 0.258, p = 0.018) was observed.Conclusion: Sputum loads of TTV DNA could be a novel indicator for lung function and disease severity assessment in COPD patients.

Abstract P30: Long-term outcomes of cancer patients infected with COVID-19

Abstract Background Patients with cancer appear to have poor outcomes with COVID-19 infection. Cohort analyses of short-term outcomes of COVID-19 (C19)-infected cancer patients (pts) have reported mortality rates ranging from 10 to 30%. Little is known about the long-term outcomes of cancer pts infected with C19. Here, we present an analysis of long-term outcomes of a cohort of active cancer pts with C19 infection. Methods This was a single center retrospective analysis of active cancer pts who tested positive for SARS-CoV-2 virus between 3/1/20- 9/30/20. Key inclusion criteria included a positive SARS-CoV-2 PCR test and an active cancer diagnosis within 90 days of a positive C19 test. We examined the rates of hospitalization for C19 infection, readmission, and C19-related mortality at 30-, 60-, 90-, and 120-day follow-up. Rates of persistent symptoms and systemic complications of C19 infection were described. Results We identified 81 active cancer pts with PCR-confirmed SARS-CoV-2 infection. Among this cohort, the median age was 55 years (range: 19- 89). 77% (N=62) had solid tumors and 23% (N=19) had a hematologic malignancy. 75% (N=61) were receiving an anti-cancer therapy at the time of C19 diagnosis. Median follow-up time from C19 diagnosis to last follow-up was 4.8 months (range: 0.1-9.0 mos). 32% (N=26) of the cohort required hospitalization for C19-related complications within 30 days of C19 diagnosis. Among those hospitalized, 35% (N=9/26) died from C19-related complications. Of the 17 pts who were discharged, 2 pts required readmission with a median time to readmission of 37 days. For these 2 pts, readmission was due to persistent dyspnea and hypoxia and both were treated for pneumonia with presumed bacterial superinfection. There were no additional hospitalizations for C19-related complications at 60-, 90-, and 120-day follow-up. At 90-day follow-up, 6 pts (7.4%) had been diagnosed with PE/DVT. No long-term cardiac, neurologic, or renal complications were observed. With regards to C19-related mortality, 30-day mortality was 8.6% (N=7) and 90-day mortality was 11.1% (N=9). No further C19-related deaths were observed after 90 days. All pts who died were hospitalized within 30 days of initial C19 diagnosis and remained hospitalized at the time of death. Persistent C19-related symptoms were noted in 8.2% (N=6/73) of the cohort at 60-days and 2.8% (N=2/71) at 90-day follow-up. Dyspnea was the most common symptom. Conclusions Among a cohort of active cancer pts with C19 infection, these data suggest that much of the morbidity and mortality associated with C19 infection appears to occur early, with decreased incidence of late complications beyond 30 days. Cancer pts who do not require hospitalization early in their infection course appear to have a decreased rate of late complications. Readmissions for C19-related complications were low, but this analysis was limited by a low number of pts. Achieving a better understanding of long-term outcomes of C19 pts with cancer will help us to better approach oncologic care as the pandemic continues. Citation Format: Justin Shaya, Angelo Cabal, Pedram Razavi, Rana R. McKay. Long-term outcomes of cancer patients infected with COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P30.

Angiotensin enzyme inhibitors and angiotensin receptor blockers as protective factors in COVID-19 mortality: a retrospective cohort study.

Targeting the renin-angiotensin system is proposed to affect mortality due to coronavirus disease 2019 (COVID-19). We aimed to compare the mortality rates in COVID-19 patients who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) and those who did not. In this retrospective cohort study, mortality was considered as the main outcome measure. All underlying diseases were assessed by the chronic use of medications related to each condition. We defined two main groups based on the ACEIs/ARBs administration. A logistic regression model was designed to define independent predictors of mortality as well as a Cox regression analysis. In total, 2553 patients were included in this study. The mortality frequency was higher in patients with a history of underlying diseases (22.4% vs 12.7%, P value < 0.001). The mortality rate in patients who received ACEIs/ARBs were higher than non-receivers (29.3% vs. 19.5%, P value = 0.013, OR = 1.3, 95% CI 1.1, 1.7) in the univariate analysis. However, the use of ACEIs/ARBs was a protective factor against mortality in the model when adjusted for underlying conditions, length of stay, age, gender, and ICU admission (P value < 0.001, OR = 0.5, 95% CI 0.3, 0.7). The Kaplan–Meier curve showed an overall survival of approximately 85.7% after a 120-day follow-up. ACEIs/ARBs are protective factors against mortality in COVID-19 patients with HTN, and these agents can be considered potential therapeutic options in this disease. The survival probability is higher in ACEIs/ARBs receivers than non-receivers.

Reducing impulsive choice VII: effects of duration of delay-exposure training.

Impulsive choice is related to substance use disorders, obesity, and other behaviors that negatively impact human health. Reducing impulsive choice may prove beneficial in ameliorating these maladaptive behaviors. Preclinical research in rats indicates that one reliable method for producing large and lasting reductions in impulsive choice is delay-exposure (DE) training. In all six of the prior DE-training experiments, rats were given extensive experience (~ 120 training sessions) with a delayed reinforcement contingency. The present experiment evaluated if similar large and lasting reductions in impulsive choice could be achieved with less training. The duration of DE training between groups of male Wistar rats was 0 sessions (training ended after a lever-pressing acquisition criterion was met), 30, 60, or 120 sessions. Comparison groups were given the same durations of training with immediate reinforcement. A post-training assessment of impulsive choice was completed using an increasing-delay procedure. For rats assigned to the 60-session condition, impulsive choice was reassessed at a 120-day follow-up. DE training reduced impulsive choice but, contrary to expectation, reductions in impulsive choice did not increase with DE-training duration (no significant training-duration by group interaction). Importantly, 60 sessions of DE training produced reductions in impulsive choice that were comparable to prior published findings and this effect remained significant at the 120-day follow-up. Procedural elements that may be responsible for the DE-training effect, and how they could be improved in future experiments, are discussed.

120-day follow-up after proximal femoral fractures-first results from the Geriatric Trauma Registry DGU®

Geriatric trauma centers which are certified to the status of aGeriatic Trauma Center DGU® based on the criteria catalogue as outlined by the German Trauma Society (DGU), are required to participate in the Geriatric Trauma Register (ATR-DGU) for quality management and outcome analyses. The evaluation is pseudoanonymous and includes data on all treated hip fracture patients over 70 years old. This has been in regular use since 2016. This study analyzed the postoperative evaluation of gait, mortality, quality of life, hospital readmission and treatment of osteoporosis after 120 days. Avoluntary retrospective data evaluation of the ATR-DGU 120-day follow-up from 2017 was carried out. Written consent for the analysis and publication of the data was obtained from six clinics that already participated in the follow-up. The primary target parameters were mortality rate, readmission and revision rates, gait quality, osteoporosis treatment and quality of life according to EQ-5D-3L. The patient data were completely pseudonymized and a descriptive analysis was carried out. In this study 957 patients from the 6hospitals were included. The average age was 84.5 years (±6.8years). The mortality rate during the acute treatment phase was 5%. The 120-day follow-up could be evaluated in 412 patients, 10% of these required hospital readmission due to complications oft he same fracture and of these 6% required revision surgery. The mortality rate at 120 days was 12%. In 54% of the patients the fracture led to deterioration of mobility and 49% of patients received osteoporosis treatment after 120 days. The results of the EQ-5D-3L at 120 days revealed improvement as compared to the values on postoperative day 7; however, the preoperative status with respect to mobility and quality of life could not be regained. Despite the clear advantages of interdisciplinary treatment, the results are still limited concerning mobilization and quality of life. Further analysis of causative and influencing factors is necessary.

3487 Trust in Research Among Older Adults

OBJECTIVES/SPECIFIC AIMS: Adults, 60 years of age and older, are in high demand for enrollment in many types of health research. Here we aimed to examine baseline, 60-day and 120-day follow-up trust in research and researchers of Floridians 60 years of age and older engaged in University of Florida’s HealthStreet community engagement initiative. METHODS/STUDY POPULATION: HealthStreet Community Health Workers (CHWs) assess health needs and trust in research of community members and screen for dementia, before providing medical and social services referrals and linkages to opportunities to participate in relevant health research at UF. In addition, participants are followed up at 60 and 120 days. RESULTS/ANTICIPATED RESULTS: Among the 2,193 older adults assessed by CHWs, 62.6% were female, 46.8% were African American, and 6.1% Hispanic/Latino. At baseline, 28.3% reported ever being in a research study; 7.7% reported not being interested in participating in research. Trust in research and researchers was high at baseline [scored from 1 to 10 where 10 was high; mean of 7.4 each for trust in research (SD=2.0) and trust in researchers (SD=2.1)] and high at both follow-ups [60 days 7.8 (SD=2.1) and 7.7 (SD=2) for trust in research and researchers respectively; 120 days 8.0 for both (SD=1.9 and 1.8 respectively)]. DISCUSSION/SIGNIFICANCE OF IMPACT: Individuals who are 60 and older have high trust in research and researchers when approached and high interest in research. Their trust continues through work with HealthStreet CHWs. Community engagement is an important part of the pipeline for recruitment of older adults for research.

The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study.

A novel auto-cross-linked hyaluronic acid formulation (HA-ACP) has been proposed as a treatment for skin rejuvenation. This prospective pilot study aims to assess its tolerability and performance in the treatment of skin aging of the décolletage. Fifteen women (mean age 49.0±8.0 (range 30-65)) who complained about the appearance of their décolletage were prospectively enrolled and treated with three sets of HA-ACP (IAL-SYSTEM ACP®) intradermal injections, administered three weeks apart. Control visits followed at 80 and 120days from enrollment. The rejuvenating effect was assessed using the Beagley-Gibson and Fabi-Bolton scores. The investigators and the subjects also subjectively assessed skin appearance using a 1-10 scale. The rejuvenating effect and its persistence were assessed comparing the scores collected at the different experimental times by means of Wilcoxon rank tests. Adverse events and their duration were recorded and compared to those reported in the literature. The HA-ACP formulation provided a significant improvement according to the Beagley-Gibson score (p<0.005) at all time points. At the 120-day follow-up, the Fabi-Bolton score was significantly improved with respect to baseline (p<0.05). The rejuvenating effect persisted unaltered between the 80-day and the 120-day visits. At the 120-day visit, the subjects' and investigators' subjective scores were between 8 and 10 in most cases. No unexpected adverse effects were observed. All adverse effects were well tolerated and disappeared over a short period. The HA-ACP treatment under investigation is safe, well tolerated, and provides effective and long-lasting décolletage rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Proton-Pump Inhibitor Use and the Risk of First-Time Ischemic Stroke in the General Population: A Nationwide Population-Based Study.

An increased risk of adverse cardiovascular events was reported for concomitant use of proton-pump inhibitors (PPIs) in patients taking antiplatelet agents. The present study aimed at determining whether PPI use alone could be associated with first-time ischemic stroke. This was a retrospective nationwide study using database from Taiwan National Health Insurance and involved subjects aged ≥20 years. In propensity score-matched analysis, patients with current PPI use were compared with propensity score-matched PPI non-use controls at a 1:1 ratio. Patients with prior stroke or hospitalization before the index date were excluded. The primary outcome measure was hospitalization with a primary diagnosis of ischemic stroke during 120-day follow-up. A parallel analysis adopting a nested case-control design was carried out. Patients hospitalized for a first-time ischemic stroke were identified and were compared with matched controls using conditional logistic regression analyses focusing on PPI use before the index date. The propensity score-matched analysis included 198,148 PPI treatment courses and control periods without PPI use. PPI use was associated with a higher risk of hospitalization due to ischemic stroke with a hazard ratio of 1.36 (95% confidence interval (CI) 1.14-1.620, P=0.001). Based on subgroup analysis, patients aged <60 years were more susceptible (P=0.043 for interaction), whereas gender, history myocardial infarction, diabetes mellitus, hypertension, use of antiplatelet agents of non-steroidal anti-inflammatory drugs, or type of PPIs had no effect on the risk. In the nested case-control analysis, 15,378 patients hospitalized owing to ischemic stroke were identified and were compared with 15,378 matched controls. An association between PPI use and increased cerebrovascular risks was identified, and the adjusted odds ratios for PPI use were 1.77 (95% CI 1.45-2.18, P<0.001) within 30 days, 1.65 (95% CI 1.31-2.08, P<0.001) between 31 and 90 days, and 1.28 (95% CI 1.03-1.59, P=0.025) between 91 and 180 days before the onset of first-time ischemic stroke. PPI use is associated with an increased risk of first-time ischemic stroke in the general population, and the risk is independent of antiplatelet agents. However, caution should be exercised when considering its clinical relevance as the magnitude of association was modest and a cause-and-effect relationship remained to be established.

Suboptimal achievement of low-density lipoprotein cholesterol targets in French patients with coronary heart disease. Contemporary data from the DYSIS II ACS/CHD study

European guidelines recommend a low-density lipoprotein cholesterol (LDL-C) target of<1.8mmol/L (70mg/dL), and/or a≥50% reduction when the target level cannot be reached, for patients at very high cardiovascular risk, and high-potency lipid-lowering therapy (LLT) in patients with an acute coronary syndrome (ACS). To document the prevalence of lipid abnormalities and the achievement of lipid targets among patients surviving an ACS and in patients with stable coronary heart disease (CHD), using data from the DYSIS II study. DYSIS II was an observational cross-sectional study conducted in 21 countries (2012-2014). We report data from the French cohort, comprising patients hospitalized with an ACS and patients diagnosed with stable CHD. Data on patient characteristics, risk factors, treatments and lipid profile were collected. LDL-C target achievement was assessed based on the European guidelines endorsed by the French Society of Cardiology. Of the 468 ACS patients, 277 (59.2%) were receiving LLT at admission to hospital; 22.6% were hospitalized for a recurrent event. Statins were used in 96.6% (450/466) of patients at discharge and in 95.1% (310/326) at 120-day follow-up, at which time 50.6% (80/158) of patients with available data achieved the LDL-C goal. Most of the 436 patients with stable CHD (97.2%) were on LLT (56.8% on high-intensity therapy); 29.2% of patients on LLT met the LDL-C treatment target<1.8mmol/L (70mg/dL). These observational data show the progress made in the treatment of ACS from the acute phase up to 3 months, and highlight key areas for improvement in the prevention of recurrent events in patients with CHD in France. The use of higher intensity or combination LLT as recommended in secondary prevention are needed to increase the achievement of LDL-C treatment targets and reduce the risk of morbidity and mortality due to CHD.

Abstract P634: The Influence Of Virtual Learning Environment On Therapy Adherence And On The White Coat Effect

Systemic arterial hypertension is a risk factor for cardiovascular diseases and has become a common public health problem. Health education associated with educational technology may be used to encourage patients’ adherence to treatment and enable them to adequately understand how harmful hypertension can be to health, thereby promoting their quality of life. OBJECTIVE: To evaluate the influence of a strategy in an individual orientation program using educational technology associated with virtual learning environment (VLE) of hypertension care on the reduction in the white coat effect and the improvement in blood pressure control to be promoted by a nurse in a hypertension unit in a government state hospital in São Paulo. METHODS AND MATERIALS:This was a randomized clinical education study conducted with two groups, the VLE group (study group, 10 patients) and the control group (16 patients). Both groups were interviewed 6 times by nurses during the 120-day follow-up at 20-day intervals. At baseline (randomization) and at the end of the study, the patients took Spielberg’s State-Trait Anxiety Inventory (STAI), the Morisky test, and the WHOQOL, a quality of life instrument, and had their blood pressure taken (ambulatory blood pressure monitoring [ABPM]). Both groups had their blood pressure, weight, and abdominal circumference measured. Only the study group had remote access to the VLE. This consisted of 6 specific educational modules, each released according to the encounter number. RESULTS: At baseline, there were no statistical differences between the two groups with respect to the sociodemographic and hemodynamic variables. At the end of the study, there was a significant statistical difference between the groups on the Morisky test (p=0.001) and on the WHOQOL with respect to domain 3 social (p=0.001). There was no statistical difference with respect to the white coat effect between the groups. Nor was there any statistical difference between the groups with respect to the association of the anxiety degree measured by STAI and the white coat effect.CONCLUSION: In light of the results, our strategy improved the quality of life in the social domain and changed the adherence behavior of the study group in relation to the forgetfulness of medication schedules.

Migration and homing of bone-marrow mononuclear cells in chronic ischemic stroke after intra-arterial injection

Cell-based treatments have been considered a promising therapy for neurological diseases. However, currently there are no clinically available methods to monitor whether the transplanted cells reach and remain in the brain. In this study we investigated the feasibility of detecting the distribution and homing of autologous bone-marrow mononuclear cells (BMMCs) labeled with Technetium-99 m ( 99mTc) in a cell-based therapy clinical study for chronic ischemic stroke. Six male patients (ages 24–65 years) with ischemic cerebral infarcts within the middle cerebral artery (MCA) between 59 and 82 days were included. Cell dose ranged from 1.25 × 10 8 to 5 × 10 8. Approximately 2 × 10 7 cells were labeled with 99mTc and intra-arterially delivered together with the unlabeled cells via a catheter navigated to the MCA. None of the patients showed any complications on the 120-day follow-up. Whole body scintigraphies indicated cell homing in the brain of all patients at 2 h, while the remaining uptake was mainly distributed to liver, lungs, spleen, kidneys and bladder. Moreover, quantification of uptake in Single-Photon Emission Computed Tomography (SPECT) at 2 h showed preferential accumulation of radioactivity in the hemisphere affected by the ischemic infarct in all patients. However, at 24 h homing could only distinguished in the brains of 2 patients, while in all patients uptake was still seen in the other organs. Taken together, these results indicate that labeling of BMMCs with 99mTc is a safe and feasible technique that allows monitoring the migration and engraftment of intra-arterially transplanted cells for at least 24 h.

Alveolar mucosa necrosis induced by utilisation of calcium hydroxide as root canal dressing

This case demonstrates the ability of calcium hydroxide to cause connective tissue necrosis. A patient with a history of trauma exhibited a large area of external inflammatory root resorption affecting the cervical and middle thirds of tooth 12. After root canal cleaning, a calcium hydroxide root canal dressing was applied to control the resorption process. After three days when the patient attended for replacement of the dressing an irregular zone of necrosis was observed on the buccal aspect of the alveolar mucosa. Careful curettage and irrigation was then performed to remove the extruded calcium hydroxide and necrotic tissue. After curettage, the root canal was accessed and irrigated with saline solution for removal of remnants of the dressing. The dressing was than replaced taking care to avoid contact with soft tissue, which might induce further damage, minimising the overflow of material. Improvement in healing was observed at 15-day follow-up, with complete closure of the lesion by soft tissue. At the 120-day follow-up, no scar was detected. At 180-day follow-up, the root canal was filled only with mineral trioxide aggregate (MTA) with aid of K files #20 and #50. At two-year follow-up, there were no symptoms and the resorption process seemed to have ceased. It is important to emphasise the damage that may occur when calcium hydroxide is in close and extended contact with the soft tissues, which could happen when dressing material is extruded through a root resorption.

Gender differences in epidemiology and outcome after hip fracture

We report gender differences in the epidemiology and outcome after hip fracture from the Scottish Hip Fracture Audit, with data on admission and at 120 days follow-up from 22 orthopaedic units across the country between 1998 and 2005. Outcome measures included early mortality, length of hospital stay, 120-day residence and mobility. A multivariate logistic regression model compared outcomes between genders. The study comprised 25 649 patients of whom 5674 (22%) were men and 19 975 (78%) were women. The men were in poorer pre-operative health, despite being younger at presentation (mean 77 years (60 to 101) vs 81 years (50 to 106)). Pre-fracture residence and mobility were similar between genders. Multivariate analysis indicated that the men were less likely to return to their home or mobilise independently at the 120-day follow-up. Mortality at 30 and 120 days was higher for men, even after differences in case-mix variables between genders were considered.

Pulmonary hypertension is frequent in hyperthyroidism and normalizes after therapy

Background In recent years, many authors have described several cases revealing an association between hyperthyroidism and pulmonary hypertension. This observational study was designed to evaluate the prevalence of pulmonary hypertension in hyperthyroidism and to determine the role of methimazole in regulating pulmonary vascular resistance in these patients. Methods We studied 114 patients, 78 women and 36 men, whose mean age was 51 ± 13 years. Forty-seven had Graves' disease and 67 had a nodular goiter. All subjects were ambulatory and were recruited in a consecutive order. The control group (group 2) included 20 healthy subjects matched for age and sex. Transthoracic Doppler echocardiography was performed and systolic pulmonary artery pressure (PAPs) was determined by the tricuspid regurgitation method using the Bernoulli's equation. We performed a 120-day follow-up in the patients with pulmonary hypertension and we divided them into two subgroups: group 1A ( n = 33), patients treated with methimazole, and group 1B ( n = 17), subjects treated with partial thyroidectomy. Results We found a mild pulmonary hypertension in 50 patients in group 1 (43%) and in none of those in the control group. The mean ± SD PAPs was 27.77 ± 6.56 in group 1 and 21.32 ± 2.55 in group 2. A negative correlation was found between the T.S.H. value and the level of PAPs ( r = − 0.85; p < 0.001). During the follow-up, group 1A went from a PAPs value of 34.3 ± 3.2 to 29.2 ± 3.3 after 15 days of therapy and group 1B from 34.3 ± 3.0 to 34.1 ± 2.9 ( p < 0.001). Conclusions The results of the present study demonstrate a frequent association between hyperthyroidism and mild and transient pulmonary hypertension. Subjects treated with methimazole have a more rapid drop in PAPs.

The Rorschach Ego Impairment Index: Prediction of Treatment Outcome in a Child Psychiatric Population

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.