Nonphosphate‐Binding Effects of Sevelamer—Are They of Clinical Relevance?

Sevelamer is an ion-exchanging resin that binds phosphate in the gut. Because it does so without increasing the calcium load, treatment with sevelamer may lead to less vascular calcification and better survival in chronic kidney disease patients. However, the results of available clinical studies have not been consistent; recent observations challenge the hypothesis that the extra calcium load inherent in calcium-based phosphate binder therapy increases cardiovascular mortality by accelerating vascular calcification. This reemphasizes the fact that we still lack detailed understanding on the complex relationships between vascular calcification, bone metabolism, vascular disease and outcome in the context of uremia. Thus, the role of phosphate binders may be more complex than initially anticipated and not limited to the extra calcium load. Even if detailed mechanisms of action for sevelamer are not yet clearly established (except for its lipid-lowering action), sevelamer may have a number of additional nonphosphate-lowering actions (including lipid lowering as well as improvement in endothelial function, modulation of inflammation and oxidative stress and binding of uremic toxin absorption). Whether these potentially very interesting pleiotropic effects of sevelamer may be translated into significant clinical benefits remains to be established.     

Does Use of a “Rim Cutter” Improve Quality of Cementation of the Acetabular Component of Cemented Exeter Total Hip Arthroplasty?

A randomized controlled trial was performed to assess the effect of a rim cutter device on cement mantles in modern elective total hip arthroplasty using a flanged acetabular component. Forty patients were randomized to a rim cutter (21) or control (19) group. A statistically significant improvement in cement penetration was demonstrated in zone 1 (10.1 vs 8.6 mm, P = .023), and in cement mantle thickness in zones 2 and 3 (7.8 and 6.7 mm vs 5.7 and 5.4 mm [P < .001 and P = .017]), with a reduced incidence of bottoming out of the socket (1/21 vs 8/19 [P = .007]). Cement mantle thicknesses greater than 8 mm were achieved more consistently in the rim cutter group (30% vs 2%). This technique improves cement penetration and mantle thickness in a reliable manner.     

Involvement of α<Subscript>v</Subscript>β<Subscript>3</Subscript> integrins in osteoclast function

Integrins are heterodimeric adhesion receptors that mediate cell–matrix interaction. Osteoclast exhibits high expression of the α_vβ₃ integrin, which binds to a variety of extracellular matrix proteins including vitronectin, osteopontin, and bone sialoprotein. Arg-Gly-Asp (RGD)-containing peptides, RGD-mimetics, and blocking antibodies to α_vβ₃ integrin were shown to inhibit bone resorption in vitro and in vivo, suggesting that this integrin may play an important role in regulating osteoclast function. Several lines of evidence have demonstrated that a number of signaling molecules are involved in the α_vβ₃ integrin-dependent signaling pathway, including c-Src, Pyk2, c-Cbl, and p130^Cas. In this article, we review the history of “α_vβ₃ integrin and osteoclasts” and discuss the involvement of α_vβ₃ integrins in osteoclast function at tissue, cellular, and molecular levels. A better understanding of the role of α_vβ₃ integrin in osteoclastic bone resorption would provide opportunities for developing new therapeutics to treat human bone diseases, including rheumatoid arthritis, osteoporosis, and periodontal disease.     

Laparoscopic Management of Lap-Band<Superscript>®</Superscript> Slippage

Background. The Lap-Band^? is generally associated with a low morbidity rate. Although gastric slippage through the band remains a concern, the rate has diminished with new band placement techniques. Methods. Between November 2000 and June 2002, 198 Lap-Band? Systems were inserted in patients in the Houston, Texas, area. 4 of these patients, plus an additional patient whose Lap-Band^? had been inserted by another surgeon, developed slippages, and in each case the gastric slip was corrected and the band was salvaged and repositioned laparoscopically. To facilitate dissection and repositioning of the band in 3 of these patients, the band had to be unlocked using a simple laparoscopic technique. Results. All patients were discharged the morning following surgery with no complications and good position of the band as evidenced by esophagogram study and resolution of symptoms. After 2 to 12 months follow-up, all 5 patients remain symptom-free and continue to lose weight. Conclusions. Gastric slippage with the Lap-Band^? can be managed by laparoscopic salvage and repositioning of the slipped band.     

Whey protein: The &ldquo;whey&rdquo; forward for treatment of type 2 diabetes?

A cost-effective nutritional approach to improve postprandial glycaemia is attractive considering the rising burden of diabetes throughout the world. Whey protein, a by-product of the cheese-making process, can be used to manipulate gut function in order to slow gastric emptying and stimulate incretin hormone secretion, thereby attenuating postprandial glycaemic excursions. The function of the gastrointestinal tract plays a pivotal role in glucose homeostasis, particularly during the postprandial period, and this review will discuss the mechanisms by which whey protein slows gastric emptying and stimulates release of gut peptides, including the incretins. Whey protein is also a rich source of amino acids, and these can directly stimulate beta cells to secrete insulin, which contributes to the reduction in postprandial glycaemia. Appetite is suppressed with consumption of whey, due to its effects on the gut-brain axis and the hypothalamus. These properties of whey protein suggest its potential in the management of type 2 diabetes. However, the optimal dose and timing of whey protein ingestion are yet to be defined, and studies are required to examine the long-term benefits of whey consumption for overall glycaemic control.     

73<Superscript>rd</Superscript> Meeting — American College of Rheumatology (ACR) 44<Superscript>th</Superscript> Meeting — Association of Rheumatology Health Professionals (ARHP)

Reportages Photographiques / Photographs from Recent Meetings

73^rd Meeting — American College of Rheumatology (ACR) 44^th Meeting — Association of Rheumatology Health Professionals (ARHP) Philadelphie (états-Unis) / 16–21 Octobre 2009     

Haematuria; a late complication of TURP?

This study was designed to investigate the cause of haematuria for patients that had previously undergone a TURP. One hundred patients were identified in a walk-in haematuria clinic as having been treated by TURP and were prospectively investigated for the cause of bleeding. Prostate regrowth was the diagnosis in 63% of cases. A diagnosis of malignancy was made for 23.5% of these patients. We have confirmed the hypothesis that for patients who present with haematuria after a TURP, the prostate is the usual source of bleeding.Prostate Cancer and Prostatic Diseases (2001) 4, 178-179.