RESUMEN
BACKGROUND: Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. MATERIAL AND METHODS: We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer's exact tests and Student's t-tests to compare the variables. We used the Kaplan-Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. RESULTS: Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. CONCLUSIONS: Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient's comorbidities should be a fundamental parameter when planning the therapeutic strategy. LEVEL OF EVIDENCE: Level 3.
Asunto(s)
Fracturas del Hombro , Comorbilidad , Humanos , Húmero , Estudios Retrospectivos , Fracturas del Hombro/cirugía , Tasa de SupervivenciaRESUMEN
Poly-(3-hydroxybutyrate-co-3-hydroxyvalerate) nanoparticles (PHBV-NPs) to encapsulate hydrocortisone (HC) for topical ophthalmic administration were prepared and characterized. The technique used to prepare the nanoparticles (NPs) was emulsification/solvent evaporation. The obtained size was 237.3⯱â¯2.7â¯nm, suitable for topical ocular administration. The obtained results for the entrapment efficiency were between 1 and 2.5% and for the drug loading were around 0.5%. The release behaviour of HC from the PHBV-NPs was also analyzed, adjusting this to a Higuchi kinetic model. For the new drug delivery system developed the ocular toxicity profile was determined by viability studies carried out on bovine keratocytes, by a Hen's Egg Test - Chorioallantoic Membrane (HET-CAM) and by a Bovine Corneal Opacity and Permeability assay (BCOP). The obtained results concluded that the new system is no cytotoxic on bovine keratocytes and is neither irritating nor produces any alteration in the transparency and in the permeability of the cornea. Confocal studies were also performed and confirmed that PHBV-NPs are able to penetrate efficiently into the corneal tissue. This novel PHBV-based drug delivery system could be a good option for topical ophthalmic administration of drugs.
Asunto(s)
Antiinflamatorios/administración & dosificación , Portadores de Fármacos/administración & dosificación , Hidrocortisona/administración & dosificación , Nanopartículas/administración & dosificación , Poliésteres/administración & dosificación , Administración Oftálmica , Animales , Antiinflamatorios/química , Bovinos , Supervivencia Celular/efectos de los fármacos , Pollos , Membrana Corioalantoides/efectos de los fármacos , Córnea/efectos de los fármacos , Córnea/metabolismo , Queratocitos de la Córnea/efectos de los fármacos , Portadores de Fármacos/química , Composición de Medicamentos , Liberación de Fármacos , Hidrocortisona/química , Nanopartículas/química , Permeabilidad , Poliésteres/químicaRESUMEN
PURPOSE: This study assessed markers of muscle damage and training adaptations to eccentric-overload flywheel resistance exercise (RE) in men and women. METHODS: Dynamic strength (1 RM), jump performance, maximal power at different percentages of 1 RM, and muscle mass in three different portions of the thigh were assessed in 16 men and 16 women before and after 6 weeks (15 sessions) of flywheel supine squat RE training. Plasma creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations were measured before, 24, 48 and 72 h after the first and the last training session. RESULTS: After training, increases in 1 RM were somewhat greater (interaction P < 0.001) in men (25 %) than in women (20 %). Squat and drop jump height and power performance at 50, 60, 70 and 80 % of 1 RM increased after training in both sexes (P < 0.05). Power improvement at 80 % of 1 RM was greater (interaction P < 0.02) in men than women. Muscle mass increased ~5 % in both groups (P < 0.05). CK increased in men after the first training session (P < 0.001), whereas the response in women was unaltered. In both sexes, LDH concentration was greater after the first training session compared with basal values (P < 0.05). After the last session, CK and LDH remained at baseline in both groups. CONCLUSIONS: These results suggest that although improvements in maximal strength and power at high loads may be slightly greater for men, eccentric-overload RE training induces comparable and favorable gains in strength, power, and muscle mass in both men and women. Equally important, it appears muscle damage does not interfere with the adaptations triggered by this training paradigm.