BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture ma...BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70.Our secondary aim is to look at predictors of poor outcomes.METHODS Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were assessed.All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified.Demographic information,the nature,and the number of surgical interventions were collated.Complications,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were reviewed.RESULTS A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle fracture.Sixteen patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing changes.Deep SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork removed.VTE incidence was 5%during the hospital stay.Eight patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and diabetic history were found to be predictive of an increase in the length of stay(general linear model;age P<0.001,number of operations P<0.001,diabetes P=0.041).CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20%chance of requiring repeated surgical intervention due to deep SSIs.The presence of a cardiac history appears to be the main predictor for wound complications.展开更多
Calcifcations across the body offer snapshots of the surrounding ionic environment at the time of their formation.Links between prostate calcification chemistry and cancer are becoming of increasing interest,particula...Calcifcations across the body offer snapshots of the surrounding ionic environment at the time of their formation.Links between prostate calcification chemistry and cancer are becoming of increasing interest,particularly in identifying biomarkers for disease.This study utilizes X-ray fluorescence mapping of 72 human prostate calcifications,measured at the 118 beamline at the Diamond Light Source,to determine the links between calcifications and their environment.This paper offers the first investigation of the elemental heterogeneity of prostate calcifica-tions,demonstrating lower relative levels of minor elements at the calcification center compared to the edge but higher levels of zinc.Importantly,this study uniquely presents links between average Fe,Cr,Mn,Cu,and Ni ratios and grade Group(a classification system for urological tumors,specifically for prostate cancer),highlighting a potential avenue of exploration for biomarkers in prostate calcifications.展开更多
文摘BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70.Our secondary aim is to look at predictors of poor outcomes.METHODS Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were assessed.All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified.Demographic information,the nature,and the number of surgical interventions were collated.Complications,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were reviewed.RESULTS A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle fracture.Sixteen patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing changes.Deep SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork removed.VTE incidence was 5%during the hospital stay.Eight patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and diabetic history were found to be predictive of an increase in the length of stay(general linear model;age P<0.001,number of operations P<0.001,diabetes P=0.041).CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20%chance of requiring repeated surgical intervention due to deep SSIs.The presence of a cardiac history appears to be the main predictor for wound complications.
文摘Calcifcations across the body offer snapshots of the surrounding ionic environment at the time of their formation.Links between prostate calcification chemistry and cancer are becoming of increasing interest,particularly in identifying biomarkers for disease.This study utilizes X-ray fluorescence mapping of 72 human prostate calcifications,measured at the 118 beamline at the Diamond Light Source,to determine the links between calcifications and their environment.This paper offers the first investigation of the elemental heterogeneity of prostate calcifica-tions,demonstrating lower relative levels of minor elements at the calcification center compared to the edge but higher levels of zinc.Importantly,this study uniquely presents links between average Fe,Cr,Mn,Cu,and Ni ratios and grade Group(a classification system for urological tumors,specifically for prostate cancer),highlighting a potential avenue of exploration for biomarkers in prostate calcifications.
