Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative

Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow‐up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow‐up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis. © 2015 American Society for Bone and Mineral Research.     

Analysis of the relationship between age and treatment response in migraine

In migraine, headache severity varies with age. As a consequence, the effectiveness of medication may also depend on a patient's age. The purpose of this study was to assess the combined effect of age and drug treatment on headache characteristics. Using data from clinical trials of sumatriptan in adolescents and adults, we show how the interaction between age and drug exposure can be parameterised as a covariate on a Markov model that describes the decline of headache severity over three clinically defined stages (no relief, relief and pain-free status). The model explains important clinical observations: (i) the rates at which the pain relief and pain-free status were attained were found to be inversely related to age; (ii) in placebo-treated patients, the mean transit time from 'no relief' to 'relief' is 3 h for young adolescents and increases to 6 h for patients aged ≥ 30 years; and (iii) sumatriptan reduces the transit time to 2 h, irrespective of age. These findings indicate that the therapeutic gain over placebo increases with age. Prospective studies of antimigraine drugs should take this relationship into account when extrapolating efficacy data from adults to adolescents.     

Diffusionsgewichtete MRI: Isch?mische und traumatische Verletzungen des Zentralnervensystems

Die diffusionsgewichtete Magnetresonanz Tomografie (DWI) stellt ein neues Verfahren dar, welches die Bildgebung von der einfachen Darstellung der Neuroanatomie um das Feld der funktionalen und physiologischen Prozesse erweitert. Im Gegensatz zur konventionellen MRT mi?t die DWI einen vollkommen anderen physiologischen Parameter. Der Bildkontrast h?ngt von Unterschieden in der Mikrobewegung (Diffusion) der Wassermoleküle im Hirngewebe ab. Daher kann die DWI pathologische Prozesse aufzeichnen, wo konventionelle T1- und T2-gewichtete MR Bilder unauff?llig bleiben. In der klinischen Routine hat sich die DWI bei der Diagnostik des akuten Schlaganfalls und des Traumas bew?hrt. durch die M?glichkeiten zwischen L?sionen mit zytotoxischem Oedem (verminderte Diffusion) und L?sionen mit vasogenem Oedem (vermehrte Diffusion) zu unterscheiden. Cerebrale Verletzungen k?nnen so früher nachgewiesen werden. Die Messung der Diffusion in verschiedenen Raumrichtungen erlaubt es eine Vielzahl funktionaler Karten zu erstellen. Die am h?ufigsten verwendeten Karten sind die des apparent diffusion coefficients (ADC) und der isotropen Diffusion. Zus?tzlich k?nnen Karten über anisotrope Diffusion berechnet werden. Diese sollen Auskunft über die Integrit?t und Lokalisation von Nervenbahnen geben. Diese funktional-anatomische Information wird wahrscheinlich in der Fühdiagnostik von prim?ren und sekund?ren Gewebeverletzungen unterschiedlicher Ursachen eine immer wichtigere Rolle spielen und k?nnte bestehende und zukünftige neuroprotektive Behandlungen leiten und validieren.     

Symptoms of ＂Heat＂ as a Pattern of Physiopathology

Objective： The guiding criteria are considered the backbone of Chinese medicine. They have previously been described as functional features （symptoms） leading to the overall assessment of human functions on the basis of a regulatory （cybernetic） model referring to the I Ging. Methods： The Heidelberg model can explain symptoms such as created by ＂heat＂ on a rational physiological level. Results ＆ Conclusion： The overall of physiological symptoms are shown as a schematic draft. The basis of ＂heat＂ is considered to be a general increase of microcirculation in the periphery. This leads to a couple of local pathophysiological consequences and sensations like 1） red tongue （the tongue is considered an embryological somatotopic system）. 2） Sensation of warmth （by increase of capillary flow）. 3） pre-inflammatory state, leading to pain modalities like ＂worse if pressed＂, as inflammations tend to be increasingly painful under pressure; 4） reddish skin, the mechanisms by which this is induced may include the release of substance P, therefore accompanied by burning sensation. Systemic pathophysiological consequences may include. Relative lack of fluid in the larger vessels, as fluid supplies peripheral capillary flow. This may lead to water saving mechanisms like thirst, dry mucosa with do, mouth, dry nose, dry lips, dry skin, and also dry stool, yellow and sparse urine.     

Local labor unions' positions on worksite tobacco control

OBJECTIVES: This report describes local unions' positions on tobacco control initiatives and factors related to these positions. METHODS: A national random sample of local union leaders was surveyed by telephone. RESULTS: Forty-eight percent of local unions supported worksite smoking bans or restrictions, and only 8% opposed both a ban and a restriction. CONCLUSIONS: Support for tobacco control initiatives among local unions was higher than might be expected on the basis of previous evidence. Engaging unions in smoking policy formation is likely to contribute to the larger public health goal of reducing smoking and exposure to second-hand smoke among workers.     

Bronchopulmonary dysplasia and pulmonary insufficiency of prematurity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age

A review of all infants admitted to the two intensive care nurseries in Seattle from July 1, 1980, through Dec 31, 1981, was performed to evaluate the outcome of infants still requiring supplemental oxygen and/or mechanical ventilation at 1 month of age. Sixty-three infants were identified. Fifty-six infants survived to at least 2 years of age, including 11 of 13 in the subgroup of infants requiring 40% or more oxygen at 1 month of age. Eight (14%) of the 56 survivors have required prolonged rehospitalization for pneumonia or other respiratory illnesses in the first two years following birth. We conclude that the degree of gas exchange impairment assessed at 1 month of age does not predict ultimate outcome from neonatal chronic lung disease.     

Verrucous carcinoma of the female genital tract: Report of a case and review of the literature

Verrucous carcinoma (VC) of the female genital tract is a rare lesion, primarily affecting postmenopausal women. A case of VC of the vulva is reported, bringing the total number of VC of the female genital tract to 89. VC is a slowly growing, locally "pushing" tumor with a rather benign histologic appearance, and the clinical and histologic characteristics are described on the basis of the present report and a review of the literature. The treatment of VC is still a matter of discussion. It seems logical to treat the tumor by wide local excision, taking the lack of proof of spontaneous metastasis into consideration. Radiation therapy should be contraindicated, and local application of podophyllin, bleomycin therapy, and cryosurgery are ineffective methods in the treatment of VC.     

Smoking Is a Risk Factor for Recurrence of Groin Hernia

Studies of connective tissue from patients with inguinal hernia have shown that smoking may be associated with hernia formation due to a defective connective tissue metabolism. Whether smoking is a risk factor for recurrence, too, was examined in this study. From December 1990 through December 1995, 649 patients underwent hernia repair as open sutured repair (Cooper ligament or abdominal ring repair) or as open mesh repair. Five hundred forty-four eligible patients were evaluated for recurrence 2 years postoperatively. Association between recurrence and 17 patient-, disease-, and intraoperative variables were analyzed by multiple logistic regression. The results showed that smoking was significantly and independently associated with recurrence compared to nonsmoking [odds ratio (OR = 2.22; 95% confidence interval (95% CI) = 1.19–4.15)]. Open sutured repair compared to open mesh repair was the most significant predictor for recurrence (OR = 7.23; 95% CI = 3.01–17.37). Surprisingly, local anesthesia was associated with a higher risk of recurrence compared to general anesthesia (OR = 2.44; 95% CI = 1.19–5.09). Potential confounders and other risk factors for hernia recurrence such as age, alcohol consumption, previous surgery, and anatomical characteristics of the hernia were adjusted for in the analysis. In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.     

Case management for substance abusers with HIV/AIDS: a randomized clinical trial

In a random assignment study, substance-abusing patients with HIV/AIDS in a public general hospital received a brief contact condition or received 12 months of case management delivered by paraprofessionals. Patient outcomes included substance use, HIV transmission risk, physical health, psychological status, and quality of living situation. In both conditions, a significant decrease occurred in a range of problems from Intake to the 6-month interview, followed by no significant pattern of change at 12- and 18-month interviews. On major outcome variables, there were no significant differences between the brief contact and case management conditions. Sixteen percent had died by the 18-month interview. Process data indicated wide variation in the amount of case management received by participants, and the amount of case management was not related to improvement in the outcome measures. The study has limitations yet does not support the hypothesis that case management improves outcomes better than brief contact for this population.