Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients?

Aim: To compare clinical characteristics and outcome of nonagenarian hip fracture patients with younger patients aged 65–89 years. Methods: This was a cohort follow‐up study of admissions for a hip fracture between 2005–2010 (mean follow up of 3.5 years) in two teaching hospitals in the Netherlands; 230 nonagenarians and 1014 patients aged 65–89 years were included. Clinical characteristics, adverse events, mobility and mortality were compared. Results: Nonagenarians were more likely to be female and anemic (both P < 0.001), and had more trochanteric fractures (P = 0.005). The number of American Society of Anesthesiologists III/VI classified patients did not differ between the two groups. During the hospital stay, adverse events were more frequently observed in nonagenarians compared with younger patients (P < 0.001). The length of stay was significantly longer in nonagenarians (P < 0.001), and the 90‐day readmission rate was similar. Absolute mortality was higher in nonagenarians (P < 0.001), excess mortality, however, was comparable. Before admission, 40.0% of the nonagenarians lived in their own home, and 40.9% had returned 3 months postfracture. The rate of returning to their own home was lower compared with younger patients (P < 0.001). Prefracture mobility was worse in nonagenarians compared with the younger group, but 3 months after discharge, the number of patients that regained prefracture mobility was comparable in both age groups. Conclusions: Nonagenarian hip fracture patients differ significantly from younger patients aged 65–89 years with respect to clinical characteristics and long‐term outcome. However, almost half of the nonagenarians returned to their own home and more than half regained their prefracture level of mobility. Given these findings, prevention strategies for hip fracture and adverse events during hospital stay that focus particularly on frail nonagenarians are highly recommended. Geriatr Gerontol Int 2013; 13: 190–197.     

Ibandronate Prevents Bone Loss and Reduces Vertebral Fracture Risk in Male Cardiac Transplant Patients: A Randomized Double‐Blind,Placebo‐Controlled Trial

Bone loss and fractures are common complications after cardiac transplantation (CTP). The aim of this study was to investigate whether intravenous ibandronate is an effective preventive option. Thirty‐five male cardiac transplant recipients received either ibandronate (IBN) 2 mg intravenously every 3 mo or matching placebo (CTR) in addition to 500 mg calcium carbonate and 400 IE vitamin D₃. Sera were collected at CTP and every 3 mo thereafter. At baseline and 6 and 12 mo, standardized spinal X‐rays and BMD measurements were taken. Bone biopsies were taken at CTP and after 6 mo from six patients. In the IBN group, 13% of the patients sustained a new morphometric vertebral fracture compared with 53% in the CTR group (absolute risk reduction [ARR], 40%; relative risk reduction [RRR], 75%; p = 0.04). BMD remained unchanged with IBN treatment but in the CTR group decreased at the lumbar spine by 25% and at the femoral neck by 23% (both p < 0.0001) over the 1‐yr period. Serum bone resorption markers carboxy‐terminal telopeptide region of type I collagen (sCTX) and TRACP 5b were significantly increased in the CTR group and decreased in the IBN group at all time points compared with baseline. In contrast, both osteocalcin and bone‐specific alkaline phosphatase levels showed, after a similar decrease over the first 3 mo in both groups, a marked rise in the CTR subjects and steadily declining levels in the IBN patients throughout the remainder of the study period. Three paired biopsies were available from each group. Despite the small sample size, a difference in the relative change of eroded surface (68% in the CTR versus ?23% in the IBN group, p < 0.05) could be shown. Intravenous IBN reduced fractures, preserved bone mass, and prevented uncoupling of bone formation and resorption after CTP. The favorable effects on bone turnover were also supported by histomorphometric findings.     

Strontium ranelate: a novel concept for the treatment of osteoporosis

The di-strontium salt strontium ranelate, a novel orally active agent consisting of two atoms of stable strontium and the organic moiety ranelic acid, has been developed for the treatment of osteoporosis. It has been shown to enhance osteoblastic cell replication and increase collagen synthesis while decreasing pre-osteoclast differentiation and bone-resorbing activity of mature osteoclasts in vitro. Studies performed in healthy animals have shown that strontium ranelate not only increases bone mass at various skeletal sites but also improves mechanical properties of femoral, humeral and vertebral bones. In estrogen-deficient animals, strontium ranelate effectively inhibits increased bone resorption while maintaining bone formation. Similar results have been obtained from studies in hind limb-immobilized animals. Strontium ranelate has been investigated in a large phase III program which includes two extensive multinational, randomized, double-blind, placebo-controlled clinical trials for the treatment of severe postmenopausal osteoporosis. Before inclusion in these two studies, patients were subjected to a run-in study in order to initiate normalization of their calcium and vitamin D status. The SOTI study, aimed at assessing strontium ranelate's effect on the risk of vertebral fractures, revealed a significant reduction in the risk of new vertebral fractures in the group treated with strontium ranelate. The TROPOS study, which aimed at evaluating the effect of strontium ranelate on nonvertebral fractures, showed a significant reduction in the risk of new nonvertebral fractures and also, in a high-risk subgroup, a significant reduction in the risk of hip fractures. In both studies, the reduction in fracture risk was accompanied by an increase in bone mineral density. The increase remained significant also after correction of the bone mineral density for the higher atomic mass of strontium compared to calcium. Furthermore, an increase in serum levels of a bone formation marker and a decrease in serum levels of a bone resorption marker were observed. The spectrum of side effects comprised mild diarrhea, particularly within the first weeks of treatment, and also a slightly increased risk of venous thromboembolic events. Strontium ranelate thus appears to be a new, effective treatment to prevent fractures in postmenopausal osteoporosis with a novel mechanism of action. It can be expected for the near future that strontium ranelate will also be evaluated for other types of osteoporosis, such as male osteoporosis.     

异丙酚复合氯胺酮全麻诱导对血流动力学的影响

0　引言　我们观察氯胺酮对异丙酚静脉复合诱导时血流动力学的影响 ,并以芬太尼复合异丙酚全麻诱导做对照研究 .1　对象和方法1.1　对象　 30例 ASA ～ 级择期行全麻手术的患者 .男2 0例 ,女 10例 ,年龄 18～ 5 5岁 ,体质量 49～ 75 kg,随机分为两组 ,A组为异丙酚复合氯胺酮组 ,B组为异丙酚复合芬太尼组 ,每组 15例 .1.2　方法　术前 30 min im苯巴比妥钠 0 .1g,阿托品 0 .5mg. A组诱导为 iv异丙酚 2 mg· kg- 1 ,氯胺酮 1mg· kg- 1及维库溴胺 0 .1mg· kg- 1 . B组为 iv异丙酚 2 m g· kg- 1 ,芬太尼 2 μg· kg- 1 及维库溴胺 0 .1mg…     

Close mapping of the focal non-epidermolytic palmoplantar keratoderma (PPK) locus associated with oesophageal cancer (TOC)

Focal non-epidermolytic palmoplantar keratoderma (PPK or palmoplantar ectodermal dysplasia type III) is associated with oesophageal cancer in three families: two large pedigrees located in Liverpool, UK and in the midwestern American states and one smaller family from Germany. In these families, the PPK is inherited as autosomal dominant and has a late onset, usually manifesting between 7 and 8 years of age. The disease is characterised by thickening of the pressure areas of the soles, but is not restricted to the feet and also presents with oral leukokeratosis and follicular hyperkeratosis. The disease locus [previously termed the "tylosis oesophageal cancer gene' (TOC) locus] has been mapped to 17q23-qter by linkage analysis. This region is located telomeric to the keratin 16 gene, in which mutations have been identified in focal PPK families who show no increased cancer risk. We describe the close mapping of this locus to the interval between AFMb054zf9 and D17S1603 using haplotype analysis of additional Genethon markers in the region and show that although the American family is unlikely to be related to either of the other two, the UK and German pedigrees may share a common descent. This work provides a basis for positional cloning and candidate gene analysis in order to identify a gene that may be involved in familial oesophageal cancer.      

Cortical tibial bone volume in two strains of mice: effects of sciatic neurectomy and genetic regulation of bone response to mechanical loading.

Although C3H/HeJ (C3H) and C57BL/6J (B6) mice are similar in body size (and adult weight), and have bones of similar external size, C3H mice have higher peak bone densities than B6 mice (e.g., 53% higher peak bone density in the femora). The current studies were intended to assess the role of mechanical loading/unloading as a possible determinant of the bone density difference between these inbred strains of mice and, specifically, to assess the effect of sciatic neurectomy on histomorphometric indices of bone formation and resorption in the tibiae of female C3H and B6 mice. Groups of 10 mice of each strain were subjected to left-side sciatic neurectomy (left hindlimb immobilization) or a sham procedure. The contralateral (right) legs of each mouse were used as controls. Four weeks of immobilization produced no systemic changes in bone formation indices in either strain of mice (i.e., no change in serum alkaline phosphatase or serum osteocalcin). However, histomorphometric assessments at the tibiofibular junction showed that 4 weeks of immobilization caused a time-dependent decrease in the length of the endosteal bone forming perimeter (e.g., 14% of control single-labeled, noneroded surface at 4 weeks, p < 0.005) with a concomitant increase in the length of the endosteal bone resorbing perimeter (i.e., 424% of control eroded surface at 4 weeks, p < 0.005), in the B6 mice. These effects were associated with an increase in medullary area (132% of control, p < 0.05) at this site, in the B6 mice. The pattern of response was different in the tibiae of the C3 mice-a much smaller decrease in bone forming perimeter (88% of control at 4 weeks, p < 0.05), with no associated increase in bone resorbing perimeter, and no change in medullary area. Similar effects were seen at a second cross-sectional sampling site, in the proximal tibia. Together, these findings indicate that B6 mice are more sensitive to endosteal bone loss from hindlimb immobilization than C3H mice.     

豆豉多糖对实验性糖尿病小鼠血糖的活性作用

目的:观察豆豉中的多糖类成分对正常小鼠和糖尿病小鼠血糖的影响,探讨其降血糖的活性作用。方法:实验于2006-03/06在华北煤炭医学院药学系实验室完成。选用雄性小白鼠130只,分为3部分进行实验。①治疗性给予豆豉多糖:取30只小鼠制作糖尿病模型。造模成功后随机平均分为模型组、低剂量给药组和高剂量给药组,另取10只作为空白对照组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),模型组灌胃等体积的生理盐水,空白对照组不采取任何措施。给药4d和7d后测定各组小鼠的血糖水平。②豆豉多糖对正常小鼠血糖的影响:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续7d。末次给药2h后测定各组小鼠血糖水平。③预防性给予豆豉多糖:取30只小鼠随机平均分为对照组、低剂量给药组和高剂量给药组。低剂量和高剂量给药组小鼠分别灌胃豆豉多糖200mg/(kg·d)和400mg/(kg·d),对照组灌胃等体积的生理盐水,连续4d。灌胃结束后,腹腔注射四氧嘧啶200mg/(kg·d),3d后测定各组小鼠血糖及血清超氧化物歧化酶活性。结果:实验共纳入130只小鼠全部进入结果分析。①治疗性给予豆豉多糖对糖尿病模型小鼠血糖的影响:豆豉多糖灌胃后,模型组小鼠的血糖水平明显高于空白对照组(P<0.01)。给药4d时,高剂量和低剂量给药组与模型组比较,差异有显著性意义(P<0.01,0.05)。在给药7d后,随着多糖浓度的提高,血糖下降越明显,并呈现一定剂量-效应关系。②豆豉多糖对正常小鼠血糖的影响:豆豉多糖可明显降低正常小鼠的血糖水平(P<0.01)。③预防性给予豆豉多糖对糖尿病小鼠血糖及超氧化物歧化酶活性的影响:预防性给予小鼠豆豉多糖有明显的降血糖作用(P<0.01),说明豆豉多糖对糖尿病有一定的预防作用。与对照组比较,豆豉多糖可明显增加小鼠血清超氧化物歧化酶含量,提高超氧化物歧化酶活性。结论:豆豉多糖具有一定的降血糖作用。     

Acoustic neuromas: Gd-DTPA enhancement in MR imaging

Magnetic resonance (MR) imaging examinations were performed in ten patients with 12 acoustic neuromas before and after intravenous administration of 0.1 mmol/kg body weight gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). The degree of enhancement was greatest with the inversion recovery sequence 1,500/500/44 (repetition time [TR]/inversion time/echo delay time [TE]), followed by spin-echo (SE) 544/44 (TR/TE) sequences, then by SE 1,500/44 and SE 1,500/80 sequences. After enhancement there was a 50% reduction for measured T1 values, 33% for T2, and no significant change for proton density. There were no toxic effects on patients. Enhanced CT scans failed to demonstrate lesions in six of 12 cases. Air-CT technique improved sensitivity in four of five cases. Enhanced MR imaging added significant clinical information in two small intracanalicular tumors and in one recurrent tumor.