Association Between Vertebral Cross‐sectional Area and Vertebral Wedging in Children and Adolescents: A Cross‐sectional Analysis

A small vertebral cross‐sectional area (CSA) imparts a mechanical disadvantage that escalates the risk for vertebral fractures in elderly populations. We examined whether a small vertebral CSA is also associated with a greater degree of vertebral wedging in children. Measurements of vertebral CSA, lumbar lordosis (LL) or thoracic scoliosis angle, and vertebral wedging were obtained in 100 healthy adolescents (50 boys and 50 girls) and 25 girls with adolescent idiopathic scoliosis (AIS) using magnetic resonance imaging. Vertebral CSA of the lumbar vertebrae negatively correlated to the degree of posteroanterior vertebral wedging at L₅ (r = –0.49; p < 0.0001); this was true whether all subjects were analyzed together or boys and girls independently. In contrast, we found a positive correlation between the degree of LL and vertebral wedging (r = 0.57; p < 0.0001). Multiple regression analysis showed that the association between vertebral CSA and wedging was independent of age and body mass index. In girls with AIS, vertebral CSA negatively correlated to the degree of lateral thoracic vertebral wedging (r = –0.66; p = 0.0004), an association that persisted even after accounting for age and body mass index. Additionally, Cobb angle positively correlated to lateral thoracic vertebral wedging (r = 0.46; p = 0.021). Our cross‐sectional results support the hypothesis that smaller vertebral CSA is associated with greater vertebral deformity during growth, as in adulthood. © 2017 American Society for Bone and Mineral Research.     

Effects of Combination Denosumab and High-Dose Teriparatide Administration on Bone Microarchitecture and Estimated Strength: The DATA-HD HR-pQCT Study

In postmenopausal women at high risk of fracture, we previously reported that combined denosumab and high-dose (HD; 40 μg) teriparatide increased spine and hip bone mineral density (BMD) more than combination with standard-dose teriparatide (SD; 20 μg). To assess the effects of these combinations on bone microarchitecture and estimated bone strength, we performed high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and distal tibia in these women, who were randomized to receive either teriparatide 20 μg (n = 39) or 40 μg (n = 37) during months 0 to 9 overlapped with denosumab 60 mg s.c. given at months 3 and 9, for a 15-month study duration. The 69 women who completed at least one study visit after baseline are included in this analysis. Over 15 months, increases in total BMD were higher in the HD-group than the SD-group at the distal tibia (5.3% versus 3.4%, p = 0.01) with a similar trend at the distal radius (2.6% versus 1.0%, p = 0.06). At 15 months, cortical porosity remained similar to baseline, with absolute differences of −0.1% and −0.7% at the distal tibia and −0.4% and −0.1% at the distal radius in the HD-group and SD-group, respectively; p = NS for all comparisons. Tibial cortical tissue mineral density increased similarly in both treatment groups (1.3% [p < 0.0001 versus baseline] and 1.5% [p < 0.0001 versus baseline] in the HD-group and SD-group, respectively; p = 0.75 for overall group difference). Improvements in trabecular microarchitecture at the distal tibia and estimated strength by micro-finite element analysis at both sites were numerically greater in the HD-group compared with SD-group but not significantly so. Together, these findings suggest that short-term treatment combining denosumab with either high- or standard-dose teriparatide improves HR-pQCT measures of bone density, microstructure, and estimated strength, with greater gains in total bone density observed in the HD-group, which may be of benefit in postmenopausal women with severe osteoporosis. © 2020 American Society for Bone and Mineral Research (ASBMR).     

Reliability Block Diagrams to Model the Management of Colorectal Cancer

The present study aims to show how variousmedical and nonmedical components contribute to successand failure in the management of colorectal cancer. Thefirst encounter, subsequent diagnosis, and surgical therapy of a patient with Dukes B sigmoidcancer is modeled as a reliability block diagram with aserial and parallel arrangement of various components.The overall probability of a patient with new-onset colorectal cancer to visit a physician, becorrectly diagnosed, and undergo successful therapy is69%. The reduction in the overall success, despite thefact that the majority of components are assumed to function with failure rates of 5% or less,is a reflection of the multitude of serial subsystemsinvolved in the management of the patient. In contrast,the parallel arrangement of subsystems results in a relative insensitivity of the overallsystem to failure, a greater stability, and an improvedperformance. Since no medical system functionsperfectly, redundancy associated with parallelsubsystems assures a better overall outcome. Systemanalysis of health care provides a means to improve itsperformance.     

Gastrointestinal Endocrine Cells in an Animal Model for Human Type 2 Diabetes

Endocrine cells were investigated in variousparts of the gastrointestinal tract in an animal modelfor human type 2 diabetes, namely the homozygous obesemouse. As controls, age- and sex-matched homozygous lean mice were used. The different endocrinecell types were stained by using immunocytochemistry andquantified by computerized image analysis. The numbersof PYY- and enteroglucagon-immunoreactive (IR) cells were decreased in the colon of obesediabetic mice vis-a-vis controls. Serotonin-IR cellswere significantly decreased in numbers in the duodenumand colon. Furthermore, colonic serotonin cells had a high cell secretory index (CSI), but anunchanged nuclear area, indicating an impaired cellularrelease of this amine. There was no statisticaldifference between obese diabetic mice and lean controls regarding the numbers and CSI of antralgastrin/CCK-, somatostatin- and serotonin-; and duodenalsecretin-, gastric inhibitory peptide (GIP)-,CCK/gastrin-, and somatostatin-IR cells; nor was thereany difference regarding nuclear area, with theexception of the antral somatostatin- and duodenalGIP-IR cells. It is concluded that the abnormalities ingut endocrine cells observed in the present study might explain the gut dysmotility reported in animalmodels for human diabetes. They may also be ofimportance in gastrointestinal dysfunction occurring indiabetes patients.     

建立急性缺血性中风气虚血瘀证诊断标准的方法学探讨

为探讨建立中风病证侯诊断标准的方法,观察了１０６例急性缺血性中风气虚瘀证患者,对其证侯指标：舌、脉、症状进行了可靠性分析、主成分分析和聚类分析。根据统计分析结果并结合临床实际,初步提出急性期缺血性中风气虚血瘀症的诊断标准,包括辩病和辩证两上方面。辩病可见半身不逐、口舌歪斜、舌强语蹇或不语,ＣＴ检查符合缺血性中风改变;辩证必须有肢体瘫软、倦怠嗜卧、口唇紫暗,脉沉细等主症,并可兼见头痛而痛处不移、汗出     

不同提取方法对檀香挥发油含量及成分的影响

（目的）观察不同提取方法对檀香挥发油含量及成分的影响。（方法）应用气相色谱-质谱-计算机联用技术,对乙醚浸渍法及溶剂回流法所得的檀香油与水蒸汽蒸馏得到的挥发油质量进行了比较研究。（结果）乙醚浸渍法所得檀香油中总檀香醇的比率稍大于以水蒸汽蒸馏所得挥发油,且二者化学成分的组成及比例相类似,经石油醚回流及乙醇回流所得挥发油比率高环境污染 蒸汽蒸馏法;其总檀香醇的含量及其他化学成分含量则与之相近。（结论）乙醚浸渍法可用于檀香挥发油的定性分析。以水蒸汽蒸馏法提取檀香油难以提取完全。     

Genetic profiling and individualized prognosis of fracture

Fragility fracture is a serious public health problem in the world. The risk of fracture is determined by genetic and nongenetic clinical risk factors. This study sought to quantify the contribution of genetic profiling to fracture prognosis. The study was built on the ongoing Dubbo Osteoporosis Epidemiology Study, in which fracture and risk factors of 858 men and 1358 women had been monitored continuously from 1989 and 2008. Fragility fracture was ascertained by radiologic reports. Bone mineral density at the femoral neck was measured by dual‐energy X‐ray absorptiometry (DXA). Fifty independent genes with allele frequencies ranging from 0.01 to 0.60 and relative risks (RRs) ranging from 1.01 to 3.0 were simulated. Three predictive models were fitted to the data in which fracture was a function of (1) clinical risk factors only, (2) genes only, and (3) clinical risk factors and 50 genes. The area under the curve (AUC) for model 1 was 0.77, which was lower than that of model II (AUC = 0.82). Adding genes into the clinical risk factors model (model 3) increased the AUC to 0.88 and improved the accuracy of fracture classification by 45%, with most (41%) improvement in specificity. In the presence of clinical risk factors, the number of genes required to achieve an AUC of 0.85 was around 25. These results suggest that genetic profiling could enhance the predictive accuracy of fracture prognosis and help to identify high‐risk individuals for appropriate management of osteoporosis or intervention. © 2011 American Society for Bone and Mineral Research.     

Hydrogen-bonding-driven spontaneous gelation of water-soluble phospholipid polymers in aqueous medium

It has been found that mixing of two kinds of water-soluble phospholipids polymers, such as poly(2-methacryloyloxyethyl phosphorylcholine-co-methacrylic acid) (PMA) and poly(2-methacryloyloxyethyl phosphorylcholine-co-n-butyl methacrylate) (PMB), spontaneously forms a hydrogel in aqueous medium at room temperature without any chemical treatment. However, the mechanism of spontaneous gelation has not been clarified yet. The purpose of this study is to investigate the gelation mechanism of the hydrogel. Moreover, effects of ions on gelation and dissolution behavior were observed. We investigated the mechanism of the hydrogel formation by spectroscopic techniques and a rheological method with attention to the interactions between polymer chains. Both Raman spectroscopic analysis and FT-IR analysis revealed that carboxyl groups in methacrylic acid (MA) formed dimer when two polymer solutions were mixed, and the results of the rheological study showed dissociation of carboxyl groups caused dissolution of the hydrogel. Thus, the gelation occurred due to the formation of dimers by hydrogen bonding which acts as a physical cross-linking of polymer chains. The hydrogel dissolved in a large amount of aqueous medium. We also observed the addition of inorganic salts during the preparation of the hydrogel affected the gelation and dissolution behaviors by a rheological and a weight measuring method, respectively. The gelation period became longer in the presence of NaCl and CaCl₂ compared with that in the absence of these salts. NaCl and CaCl₂ disturbed the formation of hydrogen bonding between carboxyl groups by stabilization of carboxylate anion of the MA units. On the other hand, addition of FeCl₃ made the gelation period shorter and stabilized the hydrogel in the aqueous medium. This is because FeCl₃ can suppress dissociation of the carboxyl groups by acidic condition of FeCl₃ aqueous solution and cross-link the carboxylate anions in the PMA effectively.     

Analysis of Variance: The Fundamental Concepts

Abstract

Analysis of variance (ANOVA) is a statistical test for detecting differences in group means when there is one parametric dependent variable and one or more independent variables. This article summarizes the fundamentals of ANOVA for an intended benefit of the clinician reader of scientific literature who does not possess expertise in statistics. The emphasis is on conceptually-based perspectives regarding the use and interpretation of ANOVA, with minimal coverage of the mathematical foundations. Computational examples are provided. Assumptions underlying ANOVA include parametric data measures, normally distributed data, similar group variances, and independence of subjects. However, normality and variance assumptions can often be violated with impunity if sample sizes are sufficiently large and there are equal numbers of subjects in each group. A statistically significant ANOVA is typically followed up with a multiple comparison procedure to identify which group means differ from each other. The article concludes with a discussion of effect size and the important distinction between statistical significance and clinical significance.