Improving Femoral Bone Density Measurements

Femoral bone density measurements are clinically important because of their strong relationship with hip fracture. However, current densitometers have not improved upon femoral densitometry since the introduction of dual-energy X-ray absorptiometry (DXA) systems. Recently, several advances in DXA measurement of the proximal femur have been proposed by various published studies. These advances can be added to existing DXA systems, while maintaining the conventional femoral regions of interest. Both upper neck bone mineral density (BMD) and hip axis length have been reported to be associated with hip fractures. With newer technology that enables a rapid assessment of both hips, bilateral femur measurements are now clinically practical and are of importance in those with T-scores approaching, yet not reaching, diagnostic or therapeutic thresholds. Bilateral femur measurements also reduce precision error compared to a single femur measurement, yielding precision errors less than observed at the spine. With this decrease in precision error, monitoring of bone changes is now possible at the femur with the utility comparable to the spine.     

Role of DAT‐SPECT in the diagnostic work up of Parkinsonism

The diagnosis of idiopathic Parkinson's disease (PD) can be achieved with high degrees of accuracy in cases with full expression of classical clinical features. However, diagnostic uncertainty remains in early disease with subtle or ambiguous signs. Functional imaging has been suggested to increase the diagnostic yield in parkinsonian syndromes with uncertain clinical classification. Loss of striatal dopamine nerve terminal function, a hallmark of neurodegenerative Parkinsonism, is strongly related to decreases of dopamine transporter (DAT) density, which can be measured by single photon emission computed tomography (SPECT). The use of DAT‐SPECT facilitates the differential diagnosis in patients with isolated tremor symptoms not fulfilling PD or essential tremor criteria, drug‐induced, psychogenic and vascular Parkinsonism as well as dementia when associated with Parkinsonism. This review addresses the value of DAT‐SPECT in early differential diagnosis, and its potential as a screening tool for subjects at risk of developing PD as well as issues around the assessment of disease progression. © 2007 Movement Disorder Society     

Rural Demographics Racial/Ethnic Diversification in Metropolitan and Nonmetropolitan Population Change in the United States: Implications for Health Care Provision in Rural America

The diversification of the rural population of the United States provides substantial challenges to the current and to future health care systems in rural areas. Because of a variety of historical, discriminatory, and other factors, minority populations have had lower levels of access to health care in rural as well as urban areas and higher rates of both mortality and morbidity than nonminority populations. Although minority health issues have often been seen as primarily urban issues, this article demonstrates that minority population growth has become a major component of total population growth in rural areas in the past several decades (accounting for nearly 62% of the net growth in the nonmetropolitan population of the United States in the 1980s and for nearly 42% in the 1990s), that future US population growth is likely to be largely a product of minority population growth (nearly 89% of US net population growth from 2000 to 2100 is projected to be due to minority population growth), and that the incidence of diseases and disorders in the US population will come to increasingly involve minority populations (by 2050 roughly 43% of all disease/disorder incidences would involve minority population members). The growth of younger minority populations with disproportionately impoverished socioeconomic characteristics will pose challenges for rural areas and health care systems, which also are likely to face health issues created by disproportionately older populations.     

Trichloroethylene inhibits uptake of 3H-5-hydroxytryptamine but not uptake of 3H-zimeldine or 3H-propranolol in isolated perfused rat lungs

Pulmonary uptake of 5-hydroxytryptamine (5-HT), zimeldine and propranolol were studied using the isolated perfused rat lung model. The 5-HT uptake was found to be attenuated by approximately 50 per cent in comparison to the control, when the lungs were ventilated with air containing 5,000 p.p.m. trichloroethylene. In experiments in which the active uptake of 5-HT was blocked with the selective 5-HT uptake inhibitor zimeldine (5 X 10(-6) M), the uptake of 5-HT decreased by 70 +/- 1.7 per cent (mean +/- S.E.M.). When trichloroethylene (5,000 p.p.m. and 18,000 p.p.m.) was added, no further decrease in uptake was noted. The uptake of 3H-zimeldine (10(-6) M) and 3H-propranolol (10(-6) M) was unaffected by ventilating the lungs with trichloroethylene. It is concluded that trichloroethylene inhibits the active uptake of 5-HT from the pulmonary circulation, but that it has no effect on the uptake of zimeldine or propranolol, which are taken up predominantly by passive diffusion.