males who have genetically determined prospect to become long-lived have less abdominal fat and in particular less abdominal VAT compared with controls.
ObjectiveFamilial longevity is marked by enhanced peripheral but not hepatic insulin sensitivity. The liver has a critical role in the pathogenesis of hepatic insulin resistance. Therefore we hypothesized that the extent of liver steatosis would be similar between offspring of long-lived siblings and control subjects. To test our hypothesis, we investigated the extent of liver steatosis in non-diabetic offspring of long-lived siblings and age-matched controls by measuring liver enzymes in plasma and liver fat by computed tomography (CT).Research Design and Methods:We measured nonfasting alanine transaminase (ALT), aspartate aminotransferase (AST), and Υ-glutamyl transferase (GGT) in 1625 subjects (736 men, mean age 59.1 years) from the Leiden Longevity Study, comprising offspring of long-lived siblings and partners thereof. In a random subgroup, fasting serum samples (n = 230) were evaluated and CT was performed (n = 268) for assessment of liver-spleen (L/S) ratio and the prevalence of moderate-to-severe non-alcoholic fatty liver disease (NAFLD). Linear mixed model analysis was performed adjusting for age, gender, body mass index, smoking, use of alcohol and hepatotoxic medication, and correlation of sibling relationship.ResultsOffspring of long-lived siblings had higher nonfasting ALT levels as compared to control subjects (24.3 mmol/L versus 23.2 mmol/L, p = 0.03), while AST and GGT levels were similar between the two groups. All fasting liver enzyme levels were similar between the two groups. CT L/S ratio and prevalence of moderate-to-severe NAFLD was similar between groups (1.12 vs 1.14, p = 0.25 and 8% versus 8%, p = 0.91, respectively).ConclusionsExcept for nonfasting levels of ALT, which were slightly higher in the offspring of long-lived siblings compared to controls, no differences were found between groups in the extent of liver steatosis, as assessed with liver biochemical tests and CT. Thus, our data indicate that the extent of liver steatosis is similar between offspring of long-lived siblings and control subjects.
Introduction Sliding hip screws (SHS) or cephallomedullary nails (CMN) are the fixation methods for proximal femur fractures (AO 31-A2). There is no consensus on the preferred treatment. 2-4% of these proximal femur fractures treated with a CMN develop a nonunion. Our objective was to review our results when replacing the CMN with a SHS in treating nonunion of trochanteric fractures. Method From 2013 until 2020, information was collected regarding all patients with a nonunion of a proximal femur fracture (AO 31-A2) that were initially treated with a CMN in a non-academic teaching hospital with a high volume of proximal femur fractures. All patients with a nonunion of the proximal femur fracture underwent an operation where the CMN was replaced with a SHS. Baseline characteristics were recorded, as well as union rate and complications regarding the secondary surgery. Results In total 15 patients were treated with removal of the CMN and placement of the SHS in the study period. 80% were female, average age was 72.3 years when primary surgery was performed. Most patients complained of pain during weight bearing due to the nonunion (N = 13). Mean time until revision surgery was 9.6 months. Consolidation of the nonunion was achieved in 93.3% of the cases. Pain relief was accomplished within 2 months. Complications were registered in 5 patients. Conclusion A SHS is an easy and effective secondary intervention when dealing with a nonunion of a trochanteric fracture (AO 31-A2) with high union rates without the necessity for bone grafting. Due to the higher complication rate in revision surgery, the patient should be well informed prior to surgery.
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