Further research is needed to determine whether an altered session or a repeated education session can assist in alleviating care partner stress.BACKGROUND Anterior column-posterior hemitransverse fractures are prevalent in the elderly and are often associated with quadrilateral surface (QLS) comminution. Several special QLS buttress plates have been introduced, but evidence of their comparability with traditional fixation devices is lacking. This biomechanical study aimed to compare special QLS buttress plates with traditional fixation devices. METHODS Anterior column-posterior hemitransverse fractures with an isolated QLS fragment were created on 24 composite hemipelves and were allocated to 4 fixation groups (1) infrapectineal QLS buttress plate, (2) suprapectineal QLS buttress plate, (3) suprapectineal reconstruction plate with 3 periarticular long screws, and (4) infrapectineal reconstruction plate with 3 periarticular long screws. Specimens were loaded to simulate partial weight-bearing (35 to 350 N) or full weight-bearing (75 to 750 N). A testing machine was synchronized with a 3-dimensional video tracking system to optically track displacementecial infrapectineal QLS buttress plate provides stiffness and stability comparable with those of standard fixation. However, moving the pelvic brim plate from the suprapectineal border to the infrapectineal border is not recommended for anterior column-posterior hemitransverse fractures because it significantly decreases fixation stiffness. CLINICAL RELEVANCE Special QLS buttress plates may be an alternative fixation method for anterior column-posterior hemitransverse acetabular fractures in the elderly, especially when a less invasive anterior intrapelvic approach is selected.INTRODUCTION Proton pump inhibitors (PPIs) are commonly used for gastrointestinal disorders; given they increase the systemic levels of gastrin, a trophic hormone, there is a concern about their carcinogenicity. This study evaluated the associations PPI use and the risks of gastrointestinal cancers compared with the users. METHODS We performed a nested case-control study in a large, community-based integrated healthcare setting. Cases were adults with gastric (n = 1,233), colorectal (n = 18,595), liver (n = 2,329), or pancreatic cancers (n = 567). Each case was matched with up to 10 controls by age, sex, race/ethnicity, medical facility, and enrollment duration. The primary exposure was defined as ≥2-year cumulative PPI supply. Data were obtained from pharmacy, cancer registry, and electronic medical record databases. Associations were evaluated using conditional logistic regression and adjusted for multiple confounders. We also evaluated the cancer risks separately by PPI dose, duration of use, and dose and duration. RESULTS PPI use of ≥2-years was not associated with the risks of gastric (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.81-1.42), colorectal (OR 1.05, 95% CI 0.99-1.12), liver (OR 1.14, 95% CI 0.91-1.43), or pancreatic cancers (OR 1.22, 95% CI 0.89-1.67), compared with the users. In exploratory analyses, elevated cancer risks were primarily restricted to those with ≥10 years of PPI use, but no consistent associations were found for increasing PPI dose and/or duration of use. DISCUSSION PPI use of ≥2 years was not associated with increased risks of gastrointestinal cancers. The cancer risks associated with PPI use of ≥10 years were further studied.OBJECTIVES The optimal duration of fasting after endoscopic hemostasis in patients with peptic ulcer bleeding has not yet been determined. We investigated the appropriate timing of feeding after endoscopic hemostasis in patients with high-risk peptic ulcer bleeding. METHODS This study was a randomized, single center, noninferiority trial. Between February 2014 and March 2019, consecutive patients with peptic ulcer bleeding were randomized to resume feeding either 24 or 48 hours after successful endoscopic hemostasis. A total of 209 eligible patients were included in the intention-to-treat analysis and 200 in the per-protocol (PP) analysis. The primary outcome measure was recurrent bleeding within 7 days of hemostasis.  https://www.selleckchem.com/products/tolebrutinib-sar442168.html  Noninferiority testing was performed in the PP population, and the noninferiority margin was set at 10%. Secondary outcomes included 30-day rebleeding and mortality, transfusion requirements, and length of hospital stay. RESULTS Recurrent bleeding rates at 7 days were 7.9% in the 24-hour group and 4.0% in the 48-hour group in the PP analysis; tests for noninferiority did not reach statistical significance (difference 3.9%, 95% confidence interval [CI] -2.7 to 10.5, P value for noninferiority = 0.034). The recurrent bleeding rates within 30 days were 10.9% and 4.0% in the 24- and 48-hour groups (difference 6.9%, 95% CI -0.5 to 14.2), and the 30-day mortality rates were 5.9% and 14.1%, respectively (difference -8.2%, 95% CI -16.5 to 0.1) in the PP analysis. The transfusion requirement and the length of hospital stay were similar between the 2 groups. DISCUSSION Early refeeding at 24 hours after endoscopic hemostasis is not noninferior to later refeeding at 48 hours for rebleeding in patients with high-risk peptic ulcer bleeding. Our results do not allow a recommendation of refeeding at 24 hours, rather than later refeeding in this population.OBJECTIVES To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury. DATA SOURCES Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018. STUDY SELECTION Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient's admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded. DATA EXTRACTION The study design, year, patient's demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted. DATA SYNTHESIS A total of 4,219 studies were retrieved and screened.