Inverse Correlation Between Vascular Calcification and Bone Mineral Density in Human Immunodeficiency Virus-Infected Patients

HIV-infected individuals suffer from accelerated aging, which manifests as premature cardiovascular and bone disease. However, little is known of the association of these two disorders in the HIV population. Our objective was to investigate the association between a marker of atherosclerosis (coronary artery calcium [CAC]) and low bone mineral density (BMD) in a cross-sectional cohort of HIV-infected patients. The study was conducted at the University of Modena and Reggio Emilia, Italy. A total of 636 consecutive middle-aged, HIV-infected subjects were recruited between January 2006 and December 2010. All patients underwent CAC and BMD assessment. Patients were categorized according to a CAC score <100 or >100 units based on previous literature that identified this cut-point as a marker of increased risk. Low femoral and lumbar spine BMD was defined as <25th percentile value for the study cohort. Logistic regression and bootstrap analysis were used to assess the independent association between CAC and BMD. The main outcome measure was a CAC score >100. Patients with CAC > 100 were older and more likely to be men, diabetic, and overweight. Patients with CAC < 100 had better renal function and a lower cardiovascular risk profile. After adjusting for age, sex, traditional and HIV-specific risk factors, vitamin D level, and PTH level, there was a significant association between CAC > 100 and low BMD for the femur (OR = 2.33, 95 % CI 1.09–4.99; p = 0.02) but not for the spine. Bootstrap analyses confirmed these findings. In summary, CAC was independently associated with low femoral BMD in HIV-infected patients. Future studies should test whether therapies that attenuate cardiovascular risk in HIV favorably impact bone health.     

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Background

Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered.

Methods

Nineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria.

Conclusions

The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.     

The role of vitamin D in improving physical performance in the elderly

There is an ongoing debate over the role of serum 25(OH) vitamin D [25(OH)D] levels in maintaining or improving physical performance and muscle strength. Much of the controversy is because of the variability between studies in participants' characteristics, baseline serum 25(OH)D levels, and baseline physical functioning. The aim of this ancillary study conducted within a randomized controlled clinical trial was to investigate whether supplementation with 400 or 2000 IU vitamin D₃ daily for 6 months would improve measures of physical performance and muscle strength in a community‐dwelling elderly population aged 65 to 95 years. Those with the slowest gait speed improved their ability to do chair‐stand tests after vitamin D supplementation. This finding remained significant after controlling for potential confounding variables. There was also an inverse correlation between serum 25(OH)D levels and fat mass index (FMI) among women, suggesting that higher supplementation with vitamin D is needed as weight increases. The results of this study suggest that supplementation with vitamin D may be most beneficial in older populations who have low baseline physical functioning. © 2013 American Society for Bone and Mineral Research.     

Delayed wound healing in aged skin rat models after thermal injury is associated with an increased MMP-9, K6 and CD44 expression

Age-related differences in wound healing have been documented but little is known about the wound healing mechanism after burns. Our aim was to compare histological features and immunohistochemical expression of matrix metalloproteinase-9 (MMP-9), collagen IV, K6 and CD44 in the burn wound healing process in aged and young rats.     

Quantitative ultrasonography of facial muscles

Introduction: There is no standardized method for examination of facial muscles with ultrasound. The purpose of this study was to identify those facial muscles accessible for reliable identification and to provide reference data. Methods: In healthy subjects all facial muscles were screened for visibility, separation from adjacent muscles, and reliability of landmarks. Bilateral scans of reliable muscles were performed in 40 adult volunteers. Results: Six facial muscles were clearly demarcated with ultrasound. These were: frontalis, orbicularis oculi, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis muscles. Cross-sectional area and muscle thickness showed gender differences and were independently related to age for some muscles. A significant left–right side difference was only seen for the orbicularis oculi muscle in women. Conclusions: These data demonstrate the usefulness of ultrasonography to assess facial muscles and provide reference values that can be applied in the clinical setting. Muscle Nerve 47: 878–883, 2013     

Non-steroidal and steroidal anti-inflammatory use in the context of orthodontic movement

The early phase of orthodontic tooth movement involves sterile acute inflammation of the periodontal ligament in response to biomechanical forces. Anti-inflammatories are pharmacologic agents used in medical and dentistry clinics. The aim of the study was to analyse the bone remodelling during orthodontic movement under non-steroidal and steroidal treatment. Male Wistar rats (n = 90) were randomly divided into three groups: C (control), non-steroidal anti-inflammatory drug (NSAID; potassium diclofenac), and steroidal anti-inflammatory drug (SAID; dexamethasone dissodium phosphate). The animals of the C group received 0.9 per cent saline solution, the NSAID group received potassium diclofenac CATAFLAM? (5 mg/kg), and the SAID group received dexamethasone dissodium phosphate DEXANIL? (2 mg/kg). Animals were sacrificed 3, 7, or 14 days after placement of the orthodontic appliance. The upper first molars were processed histologically; we quantified the blood vessels, Howship lacunae, and osteoclast-like cells present on the tension and compression sides of the periodontal ligament. Bone formation was evaluated under polarized light microscopy; 4.5 Image Pro-Plus? software calculated the percentage of immature/mature collagen present. The results showed that, in 3 and 7 days, NSAID and SAID groups presented fewer blood vessels, Howship lacunae, and osteoclast-like cells when compared to the control group. On the 7th and 14th days, there was a lower percentage of mature collagen in the SAID group (P < 0.001). These data demonstrate that potassium diclofenac and dexamethasone inhibit bone resorption during the initial period of orthodontic movement and that dexamethasone delays the collagen maturation process in established bone matrix.