OLORECTAL CANCER IS THE second most prevalent cancer worldwide. 1 There were about 1 million new cases and 500 000 deaths due to colorectal cancer in 2002. 1 It has been estimated that 1 in 20 healthy individuals will eventually develop colorectal cancer. Coronary artery disease (CAD) is the single leading cause of death in the United States and other industrialized countries. 2 We previously published a retrospective study that reported a strong Author Affiliations: Departments of Medicine (Drs A.

Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures.

AimDescribe the distinguishing features of heart failure (HF) patients with reduced ejection fraction (HFrEF) in the VICTORIA (Vericiguat Global Study in Patients with Heart Failure with Reduced Ejection Fraction) trial.Methods and resultsKey background characteristics were evaluated in 5050 patients randomized in VICTORIA and categorized into three cohorts reflecting their index worsening HF event. Differences within the VICTORIA population were assessed and compared with PARADIGM‐HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and COMMANDER HF (A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure). VICTORIA patients had increased risk of mortality and rehospitalization: New York Heart Association class (40% class III), atrial fibrillation (45%), diabetes (47%), hypertension (79%) and mean estimated glomerular filtration rate of 61.5 mL/min/1.73 m2. Baseline standard of HF care was very good: 60% received triple therapy. Their N‐terminal pro‐B‐type natriuretic peptide was 3377 pg/mL [interquartile range (IQR) 1992–6380]. Natriuretic peptides were 30% higher level in the 67% patients with HF hospitalization <3 months, compared to those within 3–6 months of HF hospitalization and those randomized after recent outpatient intravenous diuretic therapy. Overall the median MAGGIC (Meta‐Analysis Global Group in Chronic Heart Failure) risk score in VICTORIA was 23 (IQR 18–27) as compared to the MAGGIC risk score in PARADIGM‐HF of 20 (IQR 16–24).ConclusionsVICTORIA comprises a broadly generalizable high‐risk population of three unique clinical strata of worsening chronic HFrEF despite very good HF therapy. VICTORIA will establish the role of vericiguat, a soluble guanylate cyclase stimulator, in HFrEF.

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Stone volume, mean stone density and skin-to-stone distance were potential predictors of the successful treatment of upper ureteral stones with shock wave lithotripsy. A scoring system based on these 3 factors helps separate patients into outcome groups and facilitates treatment planning.

Recent clinical research into aneurysmal subarachnoid hemorrhage (aSAH) has confirmed the long-term effect of cognitive dysfunction on functional outcomes. We hypothesized that early cognitive impairment was a marker of permanent brain injury and hence predicted long-term functional outcome. Hong Kong Chinese patients with aneurysmal subarachnoid hemorrhage were evaluated prospectively by means of the Montreal Cognitive Assessment (MoCA) in the subacute phase (2-4 weeks after aSAH) and by neuropsychological evaluation of functional outcomes in the chronic phase (1 year after aSAH). This multi-center prospective observational study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193). One hundred and eight patients completed both the subacute and chronic phase assessments. Cognitive dysfunction in the subacute phase independently correlated with functional outcomes at 1 year, after adjusting for age, admission clinical condition, treatment modality, motor score, and mobility in the subacute phase, but the positive predictive values remained low. MoCA-assessed cognitive impairment in the subacute phase cannot accurately predict functional outcomes at 1 year. Future study should focus on understanding the relative importance of different components of early cognitive impairment.

SUMMARY BackgroundCommon risk factors exist in colorectal neoplasia (cancer or adenoma) and coronary artery disease.

NCT01369537.