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Objectives: To determine which in-hospital complications after the operative treatment of hip fractures are associated with increased in-patient, 30-day, and 1-year mortality., Design: Retrospective study., Setting: A single academic medical center and a Level 1 Trauma Center., Patient Selection Criteria: All patients who were operatively treated for hip fractures (Orthopaedic Trauma Association/AO 31A, 31B and Vancouver A, B, and C periprosthetic fractures) at a single center between October, 2014, and June, 2023., Outcome Measures and Comparisons: Occurrence of an in-hospital complication was recorded. Cohorts were based on mortality time points (during admission, 30 days, and 1 year) and compared with patients who were alive at those time points to determine which in-hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point., Results: A total of 3134 patients (average age of 79.6 years, range 18-104 years and 66.6% women) met inclusion for this study. The overall mortality rate during admission, 30 days, and 1 year was found to be 1.6%, 3.9%, and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (odds ratio [OR] 7.79, 95% confidence interval [CI], 3.22-18.82, P < 0.001) compared with other in-hospital complications. Compared with other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR 7.95, 95% CI, 1.82-34.68, P < 0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR 2.86, 95% CI, 1.21-6.77, P = 0.017) compared with other in-hospital complications., Conclusions: Postoperative sepsis, stroke, and myocardial infraction were the 3 complications most associated with mortality during admission, 30-day mortality, and 1-year mortality, respectively, during the operative treatment of hip fractures., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To examine patient demographic and clinical outcomes associated with partial articular distal femoral fractures., Methods: An IRB-approved study was conducted on a consecutive series of patients being treated for isolated partial articular distal femoral fractures at a single academic medical center between August, 2011 and July, 2023. Patient demographics, hospital quality measures and outcomes for each patient were reviewed. All fractures were fixed using screws alone or plate and screw constructs. Fractures were grouped into isolated entire medial or lateral condyle (OTA/AO 33B1 or B2) and posterior unicondylar (Hoffa) fractures (OTA/AO 33B3.2). Cohorts were compared for clinical, radiographic and complication outcomes using Chi-Square Tests and ANOVA tests., Results: A total of 30 patients were identified with a mean of 55.2 years. There were 16 (53.3%) isolated medial/lateral condylar fractures and 14 (46.7%) Hoffa fractures. There were no differences between the two fracture types in terms of baseline demographics. There was no difference in terms of length of stay or in-hospital complications between the fracture types. All fractures united. There was also no difference in range of knee motion at latest follow-up visit. Hoffa fractures required a longer time for radiographic healing (4.5 months vs. 3.05 months, p = 0.012)., Conclusion: Hoffa fractures require longer time to radiographic healing compared to other partial articular distal femoral fractures; however no other differences were seen based on fracture patterns., Level of Evidence: III., Competing Interests: Declarations. Conflict of interest: All authors declare that they have no conflicts of interest related to the content of this manuscript. Ethical approval: This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The NYU Langone Health Office of Science and Research Institutional Review Board (IRB) Langone approved this study. IRB approval was completed before this particular study/manuscript started., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objectives: To determine the most common reason for 30-day readmission following hospitalization for hip fractures., Methods: Design: A retrospective review., Setting: Single academic medical center that includes a Level 1 Trauma Center., Patient Selection Criteria: Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients that died during their initial admission were excluded., Outcome Measures and Comparisons: Patient demographics, hospital quality measures, outcomes and readmission within 30-days following discharge for each patient were reviewed. 30-day readmission reason was recorded and correlation analysis was performed., Results: A total of 3,032 patients were identified with a mean age of 82.1 years and 70.5% of patients being female. The 30-day readmission cohort was 2.6 years older (p<0.001) and 8.8% more male patients (p=0.027), had 0.5 higher CCI (p<0.001), 0.3 higher ASA class (p<0.001) and were 9.2% less independent at the time of admission (p= 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared to closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, p<0.001). Those readmitted by 30-days developed more major (16.7% vs. 8.0%) (p<0.001) and minor (50.5% vs. 36.4%) (p<0.001) complications during their initial hospitalization and had a 1.5 day longer LOS during their first admission (p<0.001). Those discharged home were less likely to be readmitted within 30-days (20.7% vs. 27.6%, (p=0.008). Multivariate regression revealed increasing ASA class (O.R. 1.47, p=0.002) and pre-injury ambulatory status (O.R. 1.42, p=0.007) were most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, COPD exacerbation and pneumonia., Conclusion: Thirty-day readmission following hip fracture was associated with older, sicker patients with decreased pre-injury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission following hip fracture was pulmonary complications., Level of Evidence: Prognostic Level III., Competing Interests: Potential Conflicts of Interest and Funding Sources: All authors declare that they have no conflicts of interest related to the content of this manuscript. No sources of funding have been granted for this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To determine if there is a correlation between time to surgery (TTS) and outcomes following repair of elbow fractures., Methods: Design: Retrospective comparative study., Setting: A single, urban hospital system., Patient Selection Criteria: Patients from March 2011 to September 2022 who sustained an isolated fracture about the elbow joint (AO/OTA 13-A, B, and C and 21-A, B, and C), underwent surgical repair, and had at least 6 months of post-operative follow up identified from an Institutional Review Board-approved database., Outcome Measures and Comparisons: Time to surgery, in days, was recorded. Radiographic and clinical follow up was obtained at all visits and a Mayo Elbow Performance Index (MEPI) was calculated based on the latest follow up. Complications recorded: elbow contracture, infection, early hardware failure, reoperation, and fracture nonunion. Multivariable regression and Spearman correlation analysis were used to determine any significant outcome differences based on time to surgery., Results: 351 patients included with a mean age of 54.8 (range: 18 - 86) years with 217 females (61.8%) and 134 males (38.2%). Eighty-two patients (23.4%) developed at least one complication while 269 patients (76.6%) did not. As a continuous variable, TTS was not correlated with arc of motion at any follow up visit nor with the latest recorded MEPI score (p > 0.05). Mean TTS for patients who did and did not experience a complication was 6 (range: 0-24) and 10 (range: 0-38) days, respectively, and this was not significantly different (p = 0.217). Complication rate and any of the individual complications were not associated with TTS following a multivariable analysis controlling for age, sex, injury mechanism, open fracture, Charlson Comorbidity Index, and AO/OTA classification (p > 0.05 for all)., Conclusions: Timing of surgery following OTA 13 A-C and 21 A-C elbow fractures was not associated with differences in post-operative complications or range of elbow motion., Level of Evidence: Level III., Competing Interests: Potential Conflicts of Interest and Funding Sources: Sanjit R. Konda receives royalty payments from Stryker. Otherwise, all authors declare that they have no conflicts of interest related to the content of this manuscript. No sources of funding have been granted for this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: To assess whether a diagnosis of preexisting anemia impacts outcomes of geriatric hip fractures., Methods: This is a retrospective comparative study conducted at a single, urban hospital system consisting of an orthopaedic specialty hospital, two level 1 trauma centers, and one university-based tertiary care hospital. Data of patients aged 55 years or older with a femoral neck, intertrochanteric, or subtrochanteric hip fracture (AO/OA 31A, 31B, and 32A-C) at a single hospital center treated from October 2014 to October 2023 were retrieved from an institutional review board-approved database. Patients were included if they had a hemoglobin measurement recorded between 6 and 12 months before hospitalization for their hip fracture. Patients were cohorted based on whether their hemoglobin values recorded anemic or not. Comparative analysis was conducted to analyze 1-year mortality, 30-day mortality, 30-day readmission, 90-day readmission, and inpatient major complications., Results: Four hundred ninety-eight patients had hemoglobin values recorded at 6 to 12 months before their surgery in the electronic medical record. Two hundred seventy-three patients (54.8%) were considered anemic at that time, whereas 225 patients (45.2%) were not. Cohorts were markedly different regarding sex, Charlson Comorbidity Index, preinjury ambulatory status, and Score for Trauma Triage in Geriatric and Middle-Aged Patients (STTGMA) score (P < 0.05 for all). Multivariable analysis revealed that chronic preinjury anemia patients had a higher likelihood of 1-year mortality and a higher risk of major inpatient complication and 30- and 90-day readmission (P < 0.05 for all)., Conclusion: Chronic preinjury anemia within 6 to 12 months before a hip fracture is associated with an increased risk of 1-year mortality, inpatient major complications, and 30- and 90-day readmission after hip fracture fixation., Level of Evidence: Level III., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Introduction: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not., Methods and Analysis: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities., Ethics and Dissemination: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although genome-wide association studies (GWAS) have successfully linked genetic risk loci to various disorders, identifying underlying cellular biological mechanisms remains challenging due to the complex nature of common diseases. We established a framework using human peripheral blood cells, physical, chemical and pharmacological perturbations, and flow cytometry-based functional readouts to reveal latent cellular processes and performed GWAS based on these evoked traits in up to 2,600 individuals. We identified 119 genomic loci implicating 96 genes associated with these cellular responses and discovered associations between evoked blood phenotypes and subsets of common diseases. We found a population of pro-inflammatory anti-apoptotic neutrophils prevalent in individuals with specific subsets of cardiometabolic disease. Multigenic models based on this trait predicted the risk of developing chronic kidney disease in type 2 diabetes patients. By expanding the phenotypic space for human genetic studies, we could identify variants associated with large effect response differences, stratify patients and efficiently characterize the underlying biology., (© 2023. The Author(s).)

Purpose: Esophageal cancer is a deadly malignancy with a 5-year survival rate of only 5% to 20%, which has remained unchanged for decades. Esophageal cancer possesses a high frequency of TP53 mutations leading to dysfunctional G 1 cell-cycle checkpoint, which likely makes esophageal cancer cells highly reliant upon G 2 -M checkpoint for adaptation to DNA replication stress and DNA damage after radiation. We aim to explore whether targeting Wee1 kinase to abolish G 2 -M checkpoint sensitizes esophageal cancer cells to radiotherapy., Experimental Design: Cell viability was assessed by cytotoxicity and colony-forming assays, cell-cycle distribution was analyzed by flow cytometry, and mitotic catastrophe was assessed by immunofluorescence staining. Human esophageal cancer xenografts were generated to explore the radiosensitizing effect of AZD1775 in vivo ., Results: The IC 50 concentrations of AZD1775 on esophageal cancer cell lines were between 300 and 600 nmol/L. AZD1775 (100 nmol/L) as monotherapy did not alter the viability of esophageal cancer cells, but significantly radiosensitized esophageal cancer cells. AZD1775 significantly abrogated radiation-induced G 2 -M phase arrest and attenuation of p-CDK1-Y15. Moreover, AZD1775 increased radiation-induced mitotic catastrophe, which was accompanied by increased γH2AX levels, and subsequently reduced survival after radiation. Importantly, AZD1775 in combination with radiotherapy resulted in marked tumor regression of esophageal cancer tumor xenografts., Conclusions: Abrogation of G 2 -M checkpoint by targeting Wee1 kinase with AZD1775 sensitizes esophageal cancer cells to radiotherapy in vitro and in mouse xenografts. Our findings suggest that inhibition of Wee1 by AZD1775 is an effective strategy for radiosensitization in esophageal cancer and warrants clinical testing., (©2020 American Association for Cancer Research.)

Purpose of Review: Post-transplant infections present a formidable challenge to the physician due to their varied presentation. Many of these infections begin by inoculation following skin compromise or disseminate to the skin hematogenously, making cutaneous manifestations of infection an important diagnostic clue in the immunocompromised. Quality research in this field is lacking, and this articles seeks to review the literature and present a guide to physicians in order for them to suspect certain infections by their cutaneous presentation., Recent Findings: The cutaneous presentation of opportunistic infections in transplant patients is extremely varied. However, as more case reports are published, certain patterns specific to individual organisms are emerging. In addition, early recognition is improving outcomes and systemic antibiotic therapy success. Early and correct recognition of disseminated infection in the immunocompromised host can be aided by close attention to cutaneous findings. This allows early and correct antibiotic therapy and improves outcomes.