Independent from muscle power and balance performance, a creatinine clearance below 65 ml/min is a significant and independent risk factor for falls and fall-related fractures in elderly men and women diagnosed with osteoporosis

Summary  

We assessed in a cross-sectional study in elderly men and women with osteoporosis, the association between the creatinine clearance (CrCl) and the performance in different balance and muscle power and function tests and found that a decreasing creatinine clearance was significantly associated with lower balance and muscle power.     

Ultrafine particulate matter exposure impairs vasorelaxant response in superoxide dismutase 2-deficient murine aortic rings

Studies have linked exposure to ultrafine particulate matter (PM) and adverse cardiovascular events. PM-induced oxidative stress is believed to be a key mechanism underlying observed adverse vascular effects. Advanced age is one factor known to decrease antioxidant defenses and confer susceptibility to the detrimental vascular effects seen following PM exposure. The present study was designed to investigate the vasomotor responses following ultrafine PM exposure in wild type (WT) and superoxide dismutase 2-deficient (SOD2^+/–) mice that possess decreased antioxidant defense. Thoracic aortic rings isolated from young and aged WT and SOD2^+/– mice were exposed to ultrafine PM in a tissue bath system. Aortic rings were then constricted with increasing concentrations of phenylephrine, followed by relaxation with rising amounts of nitroglycerin (NTG). Data demonstrated that ultrafine PM decreased the relaxation response in both young WT and young SOD2^+/– mouse aortas, and relaxation was significantly reduced in young SOD2^+/– compared to WT mice. Ultrafine PM significantly diminished the NTG-induced relaxation response in aged compared to young mouse aortas. After ultrafine PM exposure, the relaxation response did not differ markedly between aged WT and aged SOD2^+/– mice. Data demonstrated that the greater vascular effect in aortic rings in aged mice ex vivo after ultrafine PM exposure may be attributed to ultrafine PM-induced oxidative stress and loss of antioxidant defenses in aged vascular tissue. Consistent with this conclusion is the attenuation of NTG-induced relaxation response in young SOD2^+/– mice.

Abbreviations: H₂O₂: hydrogen peroxide; NTG: nitroglycerin; PAH: polycyclic aromatic hydrocarbons; PE: l-phenylephrine; PM: particulate matter; ROS: reactive oxygen species; SOD2: superoxide dismutase 2 deficient; WT: wild type     

Coprocessing of powdered cellulose and magnesium carbonate: direct tableting versus tableting after roll compaction/dry granulation

Mixtures of magnesium carbonate (MC) with three types of powdered cellulose (M80, P290, A300) were tableted directly or after roll compaction/dry granulation. The fraction of powdered cellulose in the mixture was varied from 0% to 25% (w/w). The properties of the granules, blends, and their corresponding tablets were analyzed. Granules with a low amount of A300 showed the best flow properties, whereas the fibrous shape of the binding agents M80 and P290 impaired the free flow. Heckel plots showed clearly the different behavior of powdered cellulose in blends and granules during the tableting process. The Heckel-Plots for pure MC powder and granulated MC (MCgr) were similar. Increasing the fraction of powdered cellulose resulted in a fan-shaped set of curves, which is a reflection of an increased densification. Physical mixtures of all three powdered celluloses and granulated mixtures of M80 resulted in a higher densification compared with pure MC. In contrast, the granulated mixtures of P290 and A300 resulted in a diminished densification during tableting, which means that the coprocessed mixtures behaved differently during tableting compared with the physical mixtures. The curves were lower than those of pure MC and MCgr most pronounced at a fraction of 5% powdered cellulose. The tablet pore structure was evaluated by mercury porosimetry. The addition of P290 and A300 to the dry granules resulted in tablets with a higher fraction of smaller pores. Comparably high values for tablet tensile strength and low friability resulted from this special tablet structure. Roll compacted/dry granulated MC, coprocessed with 5% of P290 or A300, seems to be a promising excipient for direct compression. This coprocessed product combines good flow and tablet properties, and is superior to pure MC or a physical mixture of MC and PC.     

Life optimism, substance use, and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged innercity women

The development of more effective human immunodeficiency virus (HIV) prevention programs for disadvantaged women requires identification of factors associated with risk. In the present study, 158 women - all of whom met criteria indicative of HIV risk - were recruited in innercity primary healthcare clinics and administered measurements that assessed variables in three domains believed pertinent to HIV sexual risk behavior: (1) substance use in the past 3 months, (2) acquired immunodeficiency syndrome (AIDS)-specific cognitive and attitudinal factors, including AIDS risk knowledge, condom attitudes, perceived risk for AIDS, behavior change intentions, and perceived self-efficacy, and (3) life context variables, including self-esteem, fatalism, personal optimism toward the future, and current life satisfaction. When women were categorized into highest and lower groups based on their recent risk behavior, AIDS-specific cognitive and attitudinal factors, as expected, differentiated the groups. However, women at highest risk for HIV also most often used a variety of substances and scored lower in self-esteem, held views more characterized by personal fatalism and low optimism concerning the future, and had greater life dissatisfaction than women at lower risk. HIV prevention programs for disadvantaged women require attention not only to AIDS-specific knowledge, attitudes, and skills development but also to broader issues of life context that, if unaddressed, may limit women's ability and motivation to reduce risk for HIV/AIDS.     

Diaspirin cross-linked hemoglobin (DCLHb) in the treatment of severe traumatic hemorrhagic shock: a randomized controlled efficacy trial

CONTEXT: Severe, uncompensated, traumatic hemorrhagic shock causes significant morbidity and mortality, but resuscitation with an oxygen-carrying fluid might improve patient outcomes. OBJECTIVE: To determine if the infusion of up to 1000 mL of diaspirin cross-linked hemoglobin (DCLHb) during the initial hospital resuscitation could reduce 28-day mortality in traumatic hemorrhagic shock patients. DESIGN AND SETTING: Multicenter, randomized, controlled, single-blinded efficacy trial conducted between February 1997 and January 1998 at 18 US trauma centers selected for their high volume of critically injured trauma patients, but 1 did not enroll patients. PATIENTS: A total of 112 patients with traumatic hemorrhagic shock and unstable vital signs or a critical base deficit, who had a mean (SD) patient age of 39 (20) years. Of the infused patients, 79% were male and 56% were white. An exception to informed consent was used when necessary. INTERVENTION: All patients were to be infused with 500 mL of DCLHb or saline solution. Critically ill patients who still met entry criteria could have received up to an additional 500 mL during the 1-hour infusion period. MAIN OUTCOME MEASURES: Twenty-eight day mortality, 28-day morbidity, 48-hour mortality, and 24-hour lactate levels. RESULTS: Of the 112 patients, 98 (88%) were infused with DCLHb or saline solution. At 28 days, 24 (46%) of the 52 patients infused with DCLHb died, and 8 (17%) of the 46 patients infused with the saline solution died (P = .003). At 48 hours, 20 (38%) of the 52 patients infused with DCLHb died and 7 (15%) of the 46 patients infused with the saline solution died (P = .01). The 28-day morbidity rate, as measured by the multiple organ dysfunction score, was 72% higher in the DCLHb group (P = .03). There was no difference in adverse event rates or the 24-hour lactate levels. CONCLUSIONS: Mortality was higher for patients treated with DCLHb. Although further analysis should investigate whether the mortality difference was solely due to a direct treatment effect or to other factors, DCLHb does not appear to be an effective resuscitation fluid.     

Anatomy of the proximal femur as seen with three-dimensional magnetic resonance imaging

Magnetic resonance imaging (MRI) is being applied successfully to the study of the musculoskeletal system with notable recent advances, including the use of three-dimensional imaging techniques. The authors introduce three-dimensional MRI as a technique for examining proximal femoral anatomy and suggest its use as an improvement on current methods for prosthetic hip design. The proximal femurs of 14 cadavers were scanned using a three-dimensional FISP technique and the images were subsequently manipulated on a three-dimensional MRI image-processing workstation to produce rotated surface reconstructions and multiplanar reformatted images. The surface rotations showed that the marrow cavity contours closely follow the contours of the external cortex. Axially reformatted images allowed relative area measurements of the marrow cavity, quantifying the variability between subjects.     

Computed tomography of lumbar apophyseal joint lipoma: Report of three cases

Summary The authors report three cases of lumbar apophyseal joint lipoma located at the L4/L5 or L5/S1 level. CT scan makes the diagnosis easily possible; indeed erosive changes with enlargement of the upper portion of the lumbar articular joint and anterior displacement of the top of the superior facet are associated with intra-articular fatty densities. Clinical symptoms are rarely encountered and may be related to narrowing of the upper portion of the intervertebral foramen.     

Die ontogenetischen Proportions?nderungen der Hand

Zusammenfassung In der frühen Fetalzeit, (d. h. im vorliegenden Falle bei Embryonen von etwa 30 mm Scheitelsteißlänge) sind zunächst Arme, Hände und Finger plump proportioniert (Abb. 1). In der späteren Fetalzeit und um die Zeit der Geburt spitzen sich die Finger zu, während die Hand relativ breiter wird. Dadurch entsteht zunächst die Patschhand des Säuglings und der kleinen Kinder (Abb. 12). In dieser ersten Phase der Entwicklung wirkt die Hand als Ganzes zunächst noch stumpf (vgl. Abb. 12 mit Abb. 1). Erst mehrere Jahre nach der Geburt erhält auch die Hand eine spitzere Form (Abb. 13). Dadurch entsteht die relativ schlanke Hand des Erwachsenen.Mit 17 Textabbildungen     

Comparison of a Steady Flow Pump to a Preload Responsive Pulsatile Pump in Left Atrial–to–Aorta Bypass in Canines

A unique preload responsive pulsatile pump was compared to a centrifugal pump in total cardiac support in 25-kg canines (n = 6, each group) in the left atrial-to-aorta mode during 5 h of ventricular fibrillation. With steady flow, there was immediate drop in output from 2.1 +/- 1.0 L/min to 1.4 +/- 0.3 L/min, followed by further reduction to 0.9 +/- 0.2 L/min during 5 h of ventricular fibrillation. With a pulsatile pump, there was no significant reduction from control of 2.4 +/- 0.6 L/min and no decline during 5 h of ventricular fibrillation. With steady flow, systemic vascular resistance (SVR) rose significantly from 1,762 dyne-s-cm-5 immediately on pump to 3,013 dyne-s-cm-5 at 5 h. With physiologic pulsatile flow, significant elevation of SVR did not occur. When stressed, due to diminished left atrial return, the centrifugal pump displayed line chatter and streaks of microbubbles, whereas the pulsatile pump did not. Crystalloid volume replacement with the centrifugal pump was 6.5 +/- 1.9 L, and with the preload responsive pulsatile pump, 5.6 +/- 1.3 L. It is concluded that in the left atrial-to-aorta mode during 5 h of ventricular fibrillation and with comparable volume replacement, total cardiac support of canines is associated with lower SVR with physiologic pulsatile flow and is not accompanied by line chatter and cavitation with this preload responsive pump.