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Background/Objectives: Osteoarthritis (OA) is a common disease that affects almost half the population at some point in their lives, causing pain and decreased functional capacity. New conservative treatment modalities are being proposed to provide symptomatic relief and delay surgical intervention. This study aimed at evaluating the safety of the novel liposomal boundary lubricant, injected intra-articularly in patients with moderate knee OA. Additionally, the effect on the functionality and life quality was assessed. Methods: Eighteen of the twenty screened subjects met inclusion criteria and were enrolled in the study. After receiving a single IA injection of AqueousJoint, patients were prospectively evaluated at baseline and at 2, 4, 8, 12, and 26 weeks. Numeric Pain Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), Short Form Health Survey (SF12) and range of motion were also recorded. Results: The final analysis was conducted on 18 subjects. No adverse events related to the investigational product were observed in the study. No serious adverse events were observed at all. A significant decrease in pain was demonstrated at all time points vs. baseline (Friedman X2 = 35.08, p < 0.001). Significant improvement was demonstrated in KOOS pain, symptoms, sports, and ADL subscales (p < 0.001). Conclusions: Despite a relatively small sample, it was demonstrated that single IA AqueousJoint injection is a safe procedure, resulting in significant pain reduction, higher ADL score, and higher KOOS sport scores. The effects lasted up to 6 months. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect and dose‐response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. Participants and methods: This retrospective study comprises a cohort of military recruits aged 18–25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. Results: Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p <.0001). On multivariate analysis, the dose‐response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) Conclusions: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH). [ABSTRACT FROM AUTHOR]

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Thermal intolerance may limit activity in hostile environments. After heat illness, two physiologically distinct phenotypes evolve: heat tolerant (HT) and heat intolerant (HI). The recognition that heat illness alters gene expression justified revisiting the established physiological concept of HI. We used a DNA microarray to examine the global transcriptional response in peripheral blood mononuclear cells (PMBCs) from HI and HT phenotypes, categorized 2-mo postheat injury using a functional physiological heat-tolerance test (HTT, 40°C)-Recovery (R, 24°C) protocol. The impact of recurrent heat stress was studied in vitro using peripheral blood mononuclear cells (PBMCs) from controls (participants with no history of heat injury), HI, and HT (categorized by functional HTT) with a customized NanoString array. There were significant differences under basal conditions between the HI and HT. HI were more immunological alerted. Almost no shared genes were found between end-HTT and recovery phases, suggesting vast cellular plasticity. In HI, mitochondrial function was dysregulated, canonical pathways associated with exercise endurance-NRF2 and insulin were downregulated, whereas AMPK and peroxisome proliferator-activated receptor (PPAR) were upregulated. HT exhibited reciprocal responses, suggesting that energy dysregulation found in HI interfered with performance in the heat. The endoplasmic-reticulum stress response was also suppressed in HI. In vitro HTT (43°C) abolished differences between HI and HT PBMCs including the HSPs genes, whereas controls showed profound HSPs upregulation. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking is a major cause of morbidity and mortality worldwide. Several authors reported a significant negative impact of smoking on the outcome of spinal surgeries. However, comparative studies on the effect of smoking on the outcome of minimally invasive (MIS) spinal decompression are rare with conflicting results. In this study, we aimed to evaluate clinical outcomes and postoperative complications following MIS decompression in current and former smoking patients compared to those of non-smoking patients. Methods: We used our prospectively collected database to retrospectively analyse the records of 188 consecutive patients treated with MIS lumbar decompression at our institution between November 2013 and July 2017. Patients were divided into groups of smokers (S), previous smokers (PS) and non-smokers (N). The S group and the PS group comprised 31 and 40 patients, respectively. The N group included 117 patients. The outcome measures included perioperative complications, revision surgery and length of stay. Patient-reported outcome measures included a visual analogue scale (VAS) for back pain and leg pain, as well as the Oswestry disability index (ODI) for evaluating functional outcomes. Results: Demographic variables, comorbidity and other preoperative variables were comparable between the three groups. A comparison of perioperative complications and revision surgery rates showed no significant difference between the groups. All groups showed significant improvement in their ODI and VAS scores at 12 and 24 months following surgery. As shown by a multivariate analysis, current smokers had lower chances of improvement, exceeding the minimal clinical important difference (MCID) in ODI and VAS for leg pain at 12 months but not 24 months postoperatively. Conclusions: Our findings show that except for a possible delay in improvement in leg pain and disability, tobacco smoking has no substantial adverse impact on complications and revision rates following MIS spinal decompressions. [ABSTRACT FROM AUTHOR]

Background: It may be difficult to define what would constitute an abnormal spinal sagittal alignment. The same degree of malalignment may be found both in patients with pain and disability and in asymptomatic individuals. This study focuses on elderly farmers who characteristically have a kyphotic spine, in addition to local residents. It questions whether these patients experience cervical and lower back symptoms, respectively, more often than elderly people who never worked on a farm and do not have a kyphotic deformity. Previous research could have been biased by sampling patients who came to a spine clinic for treatment, whereas this study sampled asymptomatic elderly who may or may not have had kyphosis. Methods: We studied 100 local residents at their annual health checkup (22 farmers and 78 non-farmers) with a median age of 71 years (range 65–84 years). Spinal radiographs were used to measure sagittal vertical axis, lumbar lordosis, thoracic kyphosis and other measurements of sagittal malalignment. Back symptoms were measured using Oswestry Disability Index (ODI) and Neck Disability Index (NDI). The association between alignment measures and back symptoms were calculated by bivariate comparison between patient groups and by Pearson's correlation. Results: About 55% of farmers and 35% of non-farmers had abnormal radiographs (i.e., vertebral fracture). Farmers had higher measurements of sagittal vertical axis (SVA), compared to non-farmers, when measured from C7 (median 24.4 mm vs. 9.15 mm, p = 0.04) and from C2 (47.65 vs. 25.3, p = 0.03). Lumbar lordosis (LL) and thoracic kyphosis (TK) were significantly decreased in farmers vs. non-farmers (37.5 vs. 43.5, p = 0.04 and 32.5 vs. 39, p = 0.02, respectively). The ODI was likely to be higher among farmers compared to non-farmers while NDI scores showed no significant difference between farmers and non-farmers (median 11.7 vs. 6.0, p = 0.06 and median 13 vs. 12, p = 0.82, respectively). In terms of correlation among spinal parameters, LL had a higher correlation with SVA, but TK had less correlation with SVA among farmers compared to non-farmers. There was no significant correlation between disability scores and measurements of sagittal alignment. Conclusions: Farmers had higher measurements of sagittal malalignment, characterized by loss of LL, decreased TK and an increased forward translation of cervical vertebrae relative to sacrum. ODI was likely to higher in farmers compared to non-farmers although the association did not reach a significant level. These results probably indicate that the gradual development of spinal malalignment in agricultural workers does not result in excess morbidity compared to controls. [ABSTRACT FROM AUTHOR]

Aim: The orthopedic surgery unit in our suburb serves a large elderly trauma population in addition to providing elective surgeries. As patients with hip fractures have become older and at higher risk of medical complications, our hospital has initiated integrated co‐management of these patients by orthopedic surgeons and geriatricians from the point of hospital admission. The aim of this study was to evaluate the impact of the hospital policy change on hip fracture management and clinical outcome indicators. Methods: Using the difference‐in‐difference approach, in total, 288 consecutive patients with hip fractures treated during the 1 year before and 2 years after transition to orthogeriatric care from a geriatric consultation model to integrated orthogeriatric care model were compared with 576 patients from other local hospitals. Results: Despite a seasonal trend toward increased length of hospital stay in winter, the intervention significantly reduced the change in mean length of stay (mean difference [95% confidence interval], −12.9 days [−21.5 to −4.3]; P = 0.007) and discharge to home tended to change less frequently (−12.6%; P = 0.10). There was no significant reduction in mean time to surgery (−0.2 days; P = 0.83), mortality (−0.8%; P = 0.62), or complications (−1.0%; P = 0.85). Conclusions: Changing our hip fracture service from a geriatric consultation model of care to an integrated orthogeriatric model significantly reduced length of hospital stay probably due to a lower chance of discharge to home. To our knowledge, this is the first study in Japan to compare two orthogeriatric care models considering the nationwide improvement in hip fracture management. Geriatr Gerontol Int 2022; 22: 138–144. [ABSTRACT FROM AUTHOR]

Background older patients with hip fractures are arbitrarily classified as octogenarians, nonagenarians and centenarians. We have designed this study to quantify in-hospital mortality and complications among each of these groups. We hypothesised that the associations between age and in-hospital mortality and complications are continuously increasing, and that these risks increase rapidly when patients reach a certain age. Methods this research is a retrospective cohort study using nationwide database between 2010 and 2018. Patients undergoing hip fracture surgery, and aged 60 or older, were included. The associations between patient age, in-hospital mortality and complications were visualised using the restricted cubic spline models, and were analysed employing multivariable regression models. Then, octogenarians, nonagenarians and centenarians were compared. Results among a total of 565,950 patients, 48.7% (n  = 275,775) were octogenarians, 23.0% (n  = 129,937) were nonagenarians and 0.7% (n  = 4,093) were centenarians. The models presented three types of association between age, in-hospital mortality and complications: (i) a continuous increase (mortality and respiratory complications); (ii) a mild increase followed by a steep rise (intensive care unit admission, heart failure, renal failure and surgical site hematoma) and (iii) a steep increase followed by a limited change (coronary heart disease, stroke and pulmonary embolisms). Conclusion we identified three types of association between age and clinical outcomes. Patients aged 85–90 may constitute the upper threshold for age categorisations, because the risk of in-hospital complications changed dramatically at that stage. This information can improve clinical awareness of various complications and support collective decision-making. [ABSTRACT FROM AUTHOR]

Several anatomic plates for fixation of the olecranon after a fracture or an osteotomy are commercially available. They serve as an alternative for tension band wiring, which is associated with a relatively high complication rate. Plating of the olecranon reportedly might result in nonunion or malunion and eventually may require revision surgery or plate removal because of skin irritation. The authors describe a proximal periprosthetic avulsion fracture of the tip of the olecranon as a unique complication associated with the use of an anatomic plate for fixation of an olecranon osteotomy. This retrospective case series included 35 patients with comminuted distal humerus fractures treated by open reduction and internal fixation through an olecranon osteotomy with an anatomic olecranon plate. Of the 35 patients, 6 (17.1%) had postoperative olecranon tip fracture, just proximal to the osteotomy site. In all cases, the fracture line coursed through the proximal cluster of screws situated on the proximal part of the plate. Avulsion fractures of the tip of the olecranon after plating of the olecranon osteotomy could have occurred as a result of biomechanical factors. The short design of the proximal part of the plate and the high screw density in the proximal part of the olecranon could lead to increased mechanical stress during contraction of the triceps. This complication should prompt further biomechanical evaluation of the plate design. [Orthopedics. 2021;44(4):e583-e587.]. [ABSTRACT FROM AUTHOR]

Objective: To noninvasively explore the heat intolerance condition during exercise-heat stress by assessing cardiovascular (CV) performance. Design: Prospective study of participants undergoing a standard heat-tolerance test (HTT). Setting: Institutional study. Participants: Ninety-five young males: 16 heat-intolerant (HI) and 79 heat-tolerant (HT). Interventions: Cardiovascular performance during an HTT was estimated by heart rate (HR) and blood pressure measurements. Main outcome measures: The sensitivity of the cardiovascular reserve index (CVRI) and the dynamic heart rate reserve (dHRR) index to predict heat intolerance was compared. Results: A significant difference in the CV reserve during exercise-heat stress was exhibited between the HI and the HT groups. Starting at a similar level, the reduction in the CV reserve at HTT endpoint was much greater in the HI than the HT individuals (P < 0.0001), as depicted by both the CVRI and the dHRR. This result indicates a greater utilization of the CV reserve by HI individuals. The CVRI is likely to be better predictor of heat intolerance than the dHRR because the partial area under the curve in the high sensitivity (>90%) region of its receiver operating characteristic curve is higher (93.2 vs 76.8). Conclusions: More than being a predictor, the CVRI may provide a new clinical insight into heat intolerance because it noninvasively characterizes the efficiency of an individual's thermoregulatory mechanism and hints that an impaired CV reserve might underlie heat intolerance. The CVRI provides a noninvasive measurement of thermoregulation, which has been long awaited to enable on-field studies and dynamic monitoring of heat-exposed task forces. [ABSTRACT FROM AUTHOR]

Objective: Researchers have produced a hypothesis of transient heat intolerance (HI) after exertional heat stroke (EHS). Based on this hypothesis, heat-tolerance testing (HTT) has been postponed until weeks 6 to 8 after EHS and other types of exertional heat illness (EHI). We compared the HTT results of participants after either EHS or other EHI who were tested earlier (≤6-week group) versus those who were tested later (>6-week group) to verify the hypothesis. Design: Cohort study. Setting: Data obtained from records of military athletes who experienced EHS or EHI. Patients or Other Participants All participants: who underwent HTT after EHI or EHS experienced between 2014 and 2018 and for whom complete data regarding the severity of the event (rectal temperature, neurologic symptoms, and laboratory results) and HTT results were available were included. Participants with suspected EHS and those with other EHIs were evaluated separately. Main Outcome Measure(s): The percentages of participants with HI and mean probability of heat tolerance were compared between those tested within 6 weeks of the event and those tested later. Results: A total of 186 participants were included in this study (EHS: 12 in the <6-week group, 9 in the >6-week group; EHI: 94 in the <6-week group, 71 in the >6-week group). In the EHS group, the percentages with HI (33% versus 44%, P = .67) and mean probability of heat tolerance (0.82 versus 0.82, P = .98) did not differ. In the EHI group, participants who were tested after 6 weeks had a greater chance of being diagnosed with HI (38% versus 21.3%, P < .02) Conclusions: The HTT results were similar between participants with EHS who were tested early (<6 weeks) and those tested late (>6 weeks). Further investigation of heat-tolerance changes in larger cohorts of patients after EHS is required to verify the theory of transient HI. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Previous observational research has shown that elderly patients with hip fractures who are operated early (within 48 hours from admission) benefit from less short‐ and long‐term mortality compared to those operated later. The objective of this study was to present regulatory measures aimed at promotion of early hip fracture surgery and their effect on the rates of early surgery and on postoperative mortality. DESIGN: Retrospective cohort. SETTING: Single inner‐city medical center. PARTICIPANTS: Elderly patients with hip fractures operated during three time periods: 2006 to 2009 (n = 1735, no intervention), 2010 to 2013 (n = 2104, first intervention, positive reinforcement), and 2014 to 2016 (n = 1538, second intervention, positive and negative reinforcement). INTERVENTION: Two regulatory measures were introduced consecutively: staff extra wages for afternoon operations (positive reinforcement) in 2010 and making early operation rates publicly available as the Ministry of Health Quality Care Indexes (negative reinforcement) in 2013. MEASUREMENTS: Percentage of early surgeries and mortality at 1 month and 1 year postoperatively. RESULTS: A total of 5377 patients (1595 men, 3782 women; mean age, 83.1 ± 7.2 years) underwent hip surgery between 2006 and 2016. The three study groups did not differ significantly in age on admission, sex, type of hip fracture (intracapsular or extracapsular), American Society of Anesthesiologists' score, mean hemoglobin on admission, and mean socioeconomic status. The percentage of operations performed within 48 hours was 55%, 65%, and 85%, respectively (P <.001). One‐month mortality was 3.9%, 5.1%, and 5%, respectively (P >.05), and one‐year mortality was 19.2%, 18.7%, and 19.6%, respectively (P >.05). CONCLUSIONS: Management pressure on the staff to expedite hip surgery and avoid negative publicity in conjunction with additional wages for afternoon surgeries was successful at promoting earlier hip surgery. Despite the substantial increase in the rates of early surgery, however, mortality rates were not affected. J Am Geriatr Soc 67:777–783, 2019. [ABSTRACT FROM AUTHOR]

Abstract Introduction Methylphenidate (MP) use is highly prevalent among children and young adults. Previous basic and epidemiological research demonstrated an adverse effect of MP on bone mass. Studies in military recruits have shown that history of MP use before conscription was a risk factor for stress fractures (SF) during the service. Methods This study is part of the project in which the association between MP use and incidence of SF was retrospectively investigated in a cohort of healthy conscripts aged 18–25, who served for at least 12 months between 2008 and 2017. Baseline information included sex, age, weight, height, geographic origin, socioeconomic status, and education. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1–90, 91–180, or 181+ tablets during the study period. The primary outcome was at least one diagnosis of stress fracture during the study. Results Among 682,110 subjects (409,175 men [60%]), 29,888 (4.4%) had fractures. MP was used by 1681 (0.4%) men and 2828 (1%) women. In both men and women, SF incidence was significantly higher among subjects with untreated ADHD (7.9% and 5.4%, respectively) and significantly lower in subjects with treated ADHD (1.9–3%; 0.3–4.3%), compared to healthy controls (5.3% and 2.9%). After multivariate adjustment, subjects with untreated ADHD remained at an increased risk of fracture (men OR = 1.66, p < 0.001 and women OR = 1.33, p = 0.007), whereas only subjects with highest exposure to MP (180+ tablets) had significantly lower chances for fracture (men OR = 0.49, p = 0.08 and women OR = 0.09, p = 0.02), compared to healthy controls. Discussion The study has demonstrated lower risk of stress fractures with concurrent MP use. The findings in this population challenge our understanding of the MP effect on bone integrity and prompt further basic research. Highlights • Young adults with ADHD are at significantly higher adjusted risk of stress fractures compared to subjects without ADHD. • Chronic treatment with ADHD (was associated with lower adjusted risk of stress fractures compared to subjects without ADHD. • Higher socio-economic status and higher education were associated with higher risk of stress fractures [ABSTRACT FROM AUTHOR]

Methylphenidate (MP), a widely used and abused stimulant medication for ADHD, negatively affects bone mass. However, previous epidemiological studies demonstrated that MP is not associated with increased incidence of fractures in children, and may even have a protective effect due to behavior modification. This study aimed to investigate the association between MP and fracture risk in a retrospective cohort of healthy military recruits, aged 18–25, with at least 1 year of service between 2008 and 2017. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1–90, 91–180, or 181+ tablets during the study period. The primary outcome was at least one fracture diagnosis during the study. Among 682,110 subjects (409,175 men [60%]), 50,999 (7.5%) had fractures. MP was used by 1,681 (0.4%) men and 2.828 (1%) women. The fracture rates in the no ADHD, untreated ADHD, ADHD 0–90, ADHD 91–180, and ADHD 181+ groups were 10.4%, 16.4%, 8.7%, 4.8% and 5.8% in men, and 3.6%, 7.1%, 4.6%, 4.4% and 3% in women, respectively. Multivariate regression analysis confirmed an inverse dose–response association between MP and fractures in men (p < 0.001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). The study confirms previous literature and demonstrates an inverse dose–response association between MP and fracture risk in men. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3328–3333, 2018. Fracture incidence was compared between five groups of soldiers aged 18–25 with follow‐up of 12–82 months: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1–90, 91–180, or 181+ tablets of methylphenidate during the study period. There was an inverse association between methylphenidate use and fracture incidence in men (p < 0.0001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). [ABSTRACT FROM AUTHOR]

Introduction: Female soldiers serving in the Israeli Defense Forces canine unit may be at increased risk of overuse injuries related to working with military dogs. We hypothesized that this particular type of occupational exposure may lead to an increased strain of the upper extremity due to such non-physiologic motions as pulling the dog's strap or resisting the sudden pulling by the dog, and may result in an increased rate of overuse injuries.Materials and Methods: We compared incidence of overuse injuries in a retrospective cohort of female soldiers who served either in the military working dogs' unit (MWD), or in the light infantry battalions (Infantry) from 2005 to 2015. We compared injury incidence of both groups during two periods: 5 mo of basic training (neither worked with dogs) and 19 or more months of combat service. Incidence was calculated as number of diagnoses per person-months (rate ratios, RR); each diagnosis counted once per study subject. We used RR confidence intervals to compare incidence of injuries between groups.Results: There were 3,443 person-months in the MWD group and 194,590 person-months in the Infantry group. There was no difference in injury incidence between groups during the initial period of basic training. During the second period, MWDs had higher incidence of upper limb (RR = 1.45, p = 0.048) and hip (RR = 3.6, p < 0.0001) injuries. The association between service with dogs and upper limb injuries remained significant (RR = 1.09, p = 0.005) after adjusting for confounding variables in the multivariate regression analysis. Other independent predictors of the upper limb overuse injuries included each additional month of service (RR = 1.003, p = 0.008), Eastern European origin compared with Israeli-born recruits (RR = 0.97, p = 0.03), increased body weight in increments of 10 kg (RR = 1.008, p = 0.03), anemia (RR = 1.02, p = 0.02) and fatigue (RR = 1.05, p ≤ 0.0001).Conclusions: We found that service in the MWD unit was associated with increased risk of upper limb injuries. Identification of the exact mechanism of injury and targeted interventions, as well as treatment of anemia and fatigue may lead to reduction of injuries in this unit. [ABSTRACT FROM AUTHOR]

Context: The heat-tolerance test (HTT) is a screening tool for secondary prevention of exertional heat illness by the Israel Defense Forces. To discern participant tolerance, recruits are exposed to intermediate environmental and exercise stresses, and their physiological responses, core temperature, and heart rate are monitored. When their physiological measures rise at a higher rate or exceed the upper levels of absolute values compared with other participants, heat intolerance (HI) is diagnosed. Objective: To develop a mathematical model to interpret HTT results and provide a quantitative estimate of the probability of heat tolerance (PHT). Design: Cross-sectional study. Setting: Warrior Health Research Institute. Patients or Other Participants: The HTT results of 175 random individuals tested after an episode of exertional heat illness were classified qualitatively and then divided into training (n = 112) and testing (n = 63) datasets. All individuals were male soldiers (age range = 18-22 years) who had sustained an episode of definitive or suspected exertional heat stroke. Main Outcome Measure(s): Based on the decision algorithm used by the Israel Defense Forces for manual interpretation of the HTT, we designed a logistic regression model to predict the heat-tolerance state. The model used a time series of physiological measures (core temperature and heart rate) of individuals to predict the manually assigned diagnosis of HT or HI. It was initially fitted and then tested on 2 separate, random datasets. The model produced a single value, the PHT, and its predictive ability was demonstrated by prediction-density plots, receiver operating characteristic curve, contingency tables, and conventional screening test evaluation measures. Results: According to prediction-density plots of the testing set, all HT patients had a PHT of 0.7 to 1. The receiver operating characteristic curve plot showed that PHT was an excellent predictor of the manual HT interpretations (area under the curve = 0.973). Using a cutoff probability of 0.5 for the diagnosis of HI, we found that PHT had sensitivity, specificity, and accuracy of 100%, 90%, and 92.06%, respectively. Conclusions: The PHT has the potential to be substituted for manual interpretation of the HTT and to serve in a variety of clinical and research applications. [ABSTRACT FROM AUTHOR]

Anthropometric measures of body composition are often used for rapid and cost-effective estimation of percentage body fat (%BF) in field research, serial measurements and screening. Our aim was to develop a validated estimate of %BF for the general population, based on simple body circumferences measures. The study cohort consisted of two consecutive samples of health club members, designated as ‘development’ (n 476, 61 % men, 39 % women) and ‘validation’ (n 224, 50 % men, 50 % women) groups. All subjects underwent anthropometric measurements as part of their registration to a health club. Dual-energy X-ray absorptiometry (DEXA) scan was used as the ‘gold standard’ estimate of %BF. Linear regressions where used to construct the predictive equation (%BFcal). Bland–Altman statistics, Lin concordance coefficients and percentage of subjects falling within 5 % of %BF estimate by DEXA were used to evaluate accuracy and precision of the equation. The variance inflation factor was used to check multicollinearity. Two distinct equations were developed for men and women: %BFcal (men)=10·1−0·239H+0·8A−0·5N; %BFcal (women)=19·2−0·239H+0·8A−0·5N (H, height; A, abdomen; N, neck, all in cm). Bland–Altman differences were randomly distributed and showed no fixed bias. Lin concordance coefficients of %BFcal were 0·89 in men and 0·86 in women. About 79·5 % of %BF predictions in both sexes were within ±5 % of the DEXA value. The Durnin–Womersley skinfolds equation was less accurate in our study group for prediction of %BF than %BFcal. We conclude that %BFcal offers the advantage of obtaining a reliable estimate of %BF from simple measurements that require no sophisticated tools and only a minimal prior training and experience. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Portable fluoroscopy devices provide point-of-care imaging in emergency and out-patient clinics. In patients suffering from ankle syndesmosis injuries, imaging under physiologic load can lead to more accurate diagnosis, particularly in subtle cases. In this study, we compared weightbearing images obtained using a novel lightweight portable battery-powered fluoroscopy device with a conventional radiography device regarding syndesmosis examination measurements. Methods: In this prospective study, eleven healthy participants underwent bilateral three-view weightbearing imaging of both ankles using a radiography (X-ray group) device and a portable fluoroscopy system (Smart-C group). Radiographic measurements were done by two observers on anteroposterior, mortise, and lateral views were compared between the two techniques. These measurements included talar tilt, tibiofibular clear space, tibiofibular overlap, plafond malleolar angle, medial distal tibial angle, medial clear space, lateral distal tibial angle, anterior and posterior tibiofibular distance were measured using the appropriate view. Data were compared between the two techniques; the interobserver agreement was calculated within each group. P<0.05 was considered statistically significant. Results: Comparing the two imaging modalities, there was no significant difference between the measurements in Smart-C and Xray groups except plafond malleolar angle. The overall interobserver agreement was excellent between the two observers. There was no significant difference between the measures by the two observers and between the bilateral ankles. Conclusion: Our results support the use of weightbearing images using portable fluoroscopy device as an alternative for the conventional radiography systems, particularly in limited-resource settings. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Previous studies raised awareness of high mortality associated with open ankle fractures in elderly patients. Mortality among this patient population has been reported about 23-27% during the first year postoperatively. The purpose of this study was 1) to investigate the association between patient factors and occurrence of open ankle fractures and 2) to quantify the risk of mortality associated with open ankle fractures. Methods: This is a retrospective cohort study of 1,045 patients 65 years and older, with ankle fractures, who were operated between 2010 and 2020. Background medical data included patient age, gender, language, race, fracture type and comorbidities. Case-control approach and logistic regression analysis were used to identify risk factors for open fractures. Propensity score matching and survival analysis were used to measure the hazard of mortality with ankle fractures. Results: There were 128 (12.2%) patients with open ankle fractures in this cohort. Patients with open ankle fractures higher odds of belonging to the age group of 70 to 79 years (OR=1.7, p=0.03) and 80 to 89 years (OR=1.8, p=0.04), having a diagnosis of hypertension (OR=2, p=0.006) and chronic kidney disease (OR=2.9, p=0.005), and smoking (OR=1.7, p=0.049). Open ankle fractures were associated with higher risk of mortality (HR=1.7, p=0.03). Other variables related to mortality in these patients were ischemic heart disease (HR=1.9, p=0.009), chronic kidney disease (HR=1.99, p=0.02), peripheral vascular disease (HR=1.8, p=0.03) and diabetes (HR=2.1, p=0.006). Conclusion: This study identifies older patients with comorbidities as having higher risk of open, compared to closed ankle fracture. Open ankle fractures are associated with higher mortality in this population, possibly indicating the need for control of comorbidities, reduction of fall risk and barrier protection as means of primary prevention. [ABSTRACT FROM AUTHOR]

Only a few authors have reported about a new-onset headache among patients who sustained an episode of an exertional heat illness (EHI). This report presents a healthy and physically fit 20-year-old male who developed a completely new headache after an EHI event. The new headache could be aggravated or called by exertion or exposure to sun and environmental heat. It was severe enough to interfere with even moderate physical activity, but reacted well to a few hours' rest and OTC pain medications. An extensive work-up including laboratory blood tests, lumbar puncture, head CT, and CT angiogram was negative. The patient remained symptomatic on the 6-month follow-up. Continued abstinence from physical activity and waiting for spontaneous resolution were recommended. We suggest that the headache may be secondary to the hyperthermia brain damage during the EHI event and differs from exertional headache by its association with exposure to sun and environmental heat. [ABSTRACT FROM AUTHOR]

Introduction: Proton-pump inhibitors (PPI) and histamine (type 2) receptor antagonists (H2RA) have the potential to interfere with calcium metabolism. Several authors have evaluated the effect of these medications on fracture incidence in older adults. A recent large epidemiologic study demonstrated a higher risk of fractures in young adults receiving PPI.Aim: To evaluate the effect of PPI and H2RA use on fracture incidence in a large retrospective cohort of military recruits representative of general population of young adults.Methods: A retrospective cohort of 254 265 male and 234 670 female non-combat military conscripts ages 18-25. Subjects were divided into three groups by PPI use (no PPI use, 1-100 tablets and more than 100 tablets) and two groups by H2RA use (no H2RA use, any H2RA use). Multivariate logistic regression was used to adjust fracture risk for age, BMI, education level, socio-economic level, ethnic origin, occupation and duration of follow-up in months.Main Outcome Measures: At least one fracture during the study period.Results: Use of PPI and H2RA was not associated with an increased risk of fractures. In men, the predictors of an increased fracture risk were higher BMI (OR = 1.007, P < 0.001), origin from a developing country (OR = 1.15, P < 0.001) and service as a driver (OR = 1.11, P < 0.001). Higher education, higher socioeconomic status and service as an officer or as an administrative worker had a protective effect on fracture incidence. In women, fractures were associated with higher BMI (OR = 1.035, P < 0.001). Origin from a developed country, as well as service as an officer or an administrative worker was associated with lower fracture risk.Conclusions: There was no association between the use of PPI or H2-antagonists and fracture incidence in this retrospective cohort of healthy young military recruits. [ABSTRACT FROM AUTHOR]