The Anabolic Effect of Teriparatide is Undermined by Low Levels of High-Density Lipoprotein Cholesterol

Intermittent parathyroid hormone (PTH) administration has a potent ability to increase bone mass, regardless of underlying conditions or species. A recent study using LDLR ^?/? mice showed that the anabolic effect of PTH was blunted by hyperlipidemia, whereas PTH anabolism was rescued by enhancement of high-density lipoprotein cholesterol (HDL-C) function. We conducted a retrospective longitudinal study to determine whether lipid profiles also affect the anabolic effect of intermittent PTH treatment in humans. Fifty-two patients (8 males and 44 females, ages 38–85 years) with severe osteoporosis who had been treated with teriparatide (TPTD, recombinant human PTH(1–34) for 12 months were studied at Severance Hospital, Yonsei University. C-telopeptide (CTX) and osteocalcin (OCN) were measured at 0, 3, and 12 months; and total cholesterol, triglycerides, and HDL-C were measured at baseline. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at 0 and 12 months. Lumbar spine BMD increased significantly after 12 months of treatment with TPTD (10.0 ± 9.3 %, p < 0.001). Initial 3-month changes in CTX and OCN levels revealed positive correlations with the increase in lumbar BMD (r = 0.546, p = 0.001 and r = 0.500, p = 0.006, respectively). Moreover, percentage change in lumbar BMD at 12 months showed a negative correlation with baseline total cholesterol (r = ?0.438, p = 0.009) and a positive correlation with HDL-C (r = 0.498, p = 0.016). A smaller 3-month increase in OCN and a lower HDL-C level at baseline were associated with a smaller lumbar BMD increase after TPTD treatment, even after adjustment for age, sex, and other confounding factors (β = 0.462, p = 0.031 for ΔOCN and β = 0.670, p = 0.004 for HDL-C). Plasma levels of lipids, especially HDL-C, seem to be associated with the extent of osteoanabolic effects of TPTD in humans.     

Correlation Between Fluid–Fluid Levels on Initial MRI and the Response to Chemotherapy in Stage IIB Osteosarcoma

Background

The presence of fluid–fluid levels (FFLs) on osteosarcoma magnetic resonance imaging (MRI) is underestimated as a nonspecific finding; however, we hypothesized that FFL in conventional osteosarcoma may be indicative of chemoresistance.

Methods

In 567 stage IIB osteosarcoma patients, we evaluated the following: the incidence of FFL and their correlation with other clinicopathological variables; tumor volume change after chemotherapy and survival according to the presence of FFL; and the relationship between survival and the extent of FFL.

Results

One hundred eight (19 %) tumors showed FFL on initial MRI. FFL were correlated with proximal humeral location (P = 0.017), osteolytic on plain radiographs (P < 0.001), tumor enlargement after chemotherapy (P < 0.001), and poor histological response (P = 0.005). Large tumor (P < 0.01), proximal tumor location (P = 0.01), and presence of FFL (P < 0.01) were independent predictors of poor survival. Compared to the extensive FFL (more than one third of the tumor), small foci of FFL (less than one third of the tumor) showed a high tendency for tumor enlargement after chemotherapy (P < 0.001), poor histologic response (P = 0.001), and worse survival (P < 0.001).

Conclusions

FFL on initial MRI could predict tumor progression after chemotherapy. Notably, tumors with small foci of FFL (less than one third of the tumor) have a high propensity for poor outcome. Patients with this finding should be considered for risk-adapted therapy.     

Effect of a 12-week weight management program on the clinical characteristics and dietary intake of the young obese and the contributing factors to the successful weight loss

BACKGROUND/OBJECTIVES

The objectives were to investigate the effect of a 12-wk intervention with behavioral modification on clinical characteristics and dietary intakes of young and otherwise healthy obese and to identify factors for successful weight loss. The goal was to lose 0.5 kg per week by reducing 300-500 kcal/day and by increasing physical activities.

SUBJECTS AND METHODS

Forty four obese subjects (BMI > 25) and 19 normal weight subjects (BMI 18.5-23) finished the 12-week intervention. Obese subjects participated in 5 group educations and 6 individual counseling sessions. Normal weight subjects attended 6 individual counseling sessions for evaluations of dietary intake and exercise pattern. Anthropometric and clinical characteristics and 3-day dietary records were evaluated at baseline and week12.

RESULTS

Weight and serum triglyceride and free fatty acid concentrations in obese group decreased significantly with intervention. Intakes of energy, fat, and cholesterol decreased significantly in the obese. Active participation, realistic weight loss goal setting, and weight gain after high school graduation not during childhood were identified as key factors for successful weight loss.

CONCLUSIONS

The 12-week intervention with behavioral modification resulted in reduced energy and fat intakes and led to significant weight loss and improvements of clinical characteristics in the obese. The finding that those who became obese during childhood lost less weight indicates the importance of ''early'' intervention.     

Illness uncertainty and complementary and alternative medicine use in patients undergoing hemodialysis

In this study, we identified the relationships between illness uncertainty, subjective health, and the use of complementary and alternative medicine in patients undergoing hemodialysis. In total, 138 participants who were diagnosed with stages 4–5 chronic kidney disease and currently receiving hemodialysis were included. A cross‐sectional, correlational design was utilized. Illness uncertainty was associated with education, monthly income, employment, and subjective health. The use of complementary and alternative medicine was not related to illness uncertainty. Among the subdomains of illness uncertainty, ambiguity and unpredictability were related to subjective health; 24.6% of the participants were currently using complementary and alternative medicine and 19.6% had used it in the past. Such methods were mainly used for the effective treatment of diseases or relief of symptoms; 88.5% of those using complementary and alternative medicine consumed vitamins, specific foods, or dietary supplements. However, the proportion of participants who consulted with health‐care providers was not high. When planning nursing interventions for patients treated with hemodialysis, assessments on illness uncertainty and complementary and alternative medicine use are needed.     

A prospective randomised comparison of two insertion methods for i‐gel™ placement in anaesthetised paralysed patients: standard vs rotational technique

In this prospective randomised study, we compared two techniques for i‐gel^? insertion. One hundred and eighty‐one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i‐gel was inserted using the standard technique. In the rotation group (n = 90), the i‐gel was rotated 90° anticlockwise in the mouth and re‐rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs 87 (97%; p = 0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cmH₂O vs 27.1 (9.4) cmH₂O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i‐gel insertion.