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101.
Fran Llopis-Cardona Carmen Armero Isabel Hurtado Aníbal García-Sempere Salvador Peiró Clara L Rodríguez-Bernal Gabriel Sanfélix-Gimeno 《Journal of bone and mineral research》2022,37(6):1200-1208
Osteoporotic hip fractures in older people may confer an increased risk of subsequent hip fractures and death. The aim of this study was to estimate the cumulative incidence of both recurrent hip fracture and death in the Valencia region. We followed a cohort of 34,491 patients aged ≥65 years who were discharged alive from Valencia Health System hospitals after an osteoporotic hip fracture between 2008 and 2015, until death or end of study (December 31, 2016). Two Bayesian illness-death models were applied to estimate the cumulative incidences of recurrent hip fracture and death by sex, age, and year of discharge. We estimated 1-year cumulative incidences of recurrent hip fracture at 2.5% in women and 2.3% in men, and 8.3% and 6.6%, respectively, at 5 years. Cumulative incidences of total death were 18.3% in women and 28.6% in men at 1 year, and 51.2% and 69.8% at 5 years. One-year probabilities of death after recurrent hip fracture were estimated at 26.8% and 43.8%, respectively, and at 57.3% and 79.2% at 5 years. Our analysis showed an increasing trend in the 1-year cumulative incidence of recurrent hip fracture from 2008 to 2015, but a decreasing trend in 1-year mortality. Male sex and age at discharge were associated with increased risk of death. Women showed higher incidence of subsequent hip fracture than men although they were at the same risk of recurrent hip fracture. Probabilities of death after recurrent hip fracture were higher than those observed in the general population. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). 相似文献
102.
Pricilla Braga Laskoski Fernanda Barcellos Serralta Alcina Juliana Soares Barros Stefania Pigatto Teche Simone Hauck Cláudio Laks Eizirik 《British Journal of Psychotherapy》2020,36(1):93-110
This paper presents and discusses the outcomes of the psychodynamic psychotherapy of a patient with somatic symptom disorder and chronic diseases in a naturalistic setting. The entire treatment included 120 weekly sessions and lasted 30 months. It was interrupted by the patient. The treatment was considered successful in terms of its results. Regarding symptomatic evaluation (assessed by Outcome Questionnaire, OQ-45), the patient showed an improvement, especially during the three-month follow-up assessment period, showing a change from dysfunction to functionality. In relation to personality evaluation (assessed by the Shedler-Westen Assessment Procedure, SWAP-200), although structural changes were not completed, the patient achieved a high level of overall functioning (i.e. strengthening of the ego). The clinical evaluation and the measures provided by the instruments were in agreement. This study showed that psychodynamic psychotherapy can help patients who show characteristics such as chronic diseases and operative functioning. Moreover, the pluralistic perspective used for evaluating treatment outcome proved to be very hopeful for improving our understanding of the patient's idiosyncrasies. 相似文献
103.
104.
《International journal of occupational and environmental health》2013,19(4):475-487
AbstractAs the nanotechnology industry expands, facilities engaged in the production and use of engineered nanoscale materials (ENMs) are challenged with determining whether their processes pose a risk for worker inhalation exposure. Although there are neither regulatory exposure limits specific to ENMs nor validated measurement standards for nanomaterials in the workplace, many facilities opt to be proactive in managing uncharacterized ENMs by reducing or eliminating the potential for exposure by controlling their release into the workplace atmosphere. A field study was conducted to evaluate the effectiveness of a portable, HEPA-filtered, local exhaust ventilation system equipped with a custom-fitted flange for controlling the emission of engineered nanoscale metal oxide particulates during reactor cleanout operations. On the basis of the findings of this study, it appears that a properly designed LEV system, coupled with good work practices can be highly effective in controlling nanoscale material emissions during processes of this type. 相似文献
105.
Xiaoyu Zhang Hanfei Xu Gloria HY Li Michelle T Long Ching-Lung Cheung Ramachandran S Vasan Yi-Hsiang Hsu Douglas P Kiel Ching-Ti Liu 《Journal of bone and mineral research》2021,36(4):729-738
Osteoporosis, a disease characterized by low bone mineral density (BMD), increases the risk for fractures. Conventional risk factors alone do not completely explain measured BMD or osteoporotic fracture risk. Metabolomics may provide additional information. We aim to identify BMD-associated metabolomic markers that are predictive of fracture risk. We assessed 209 plasma metabolites by liquid chromatography with tandem mass spectrometry (LC–MS/MS) in 1552 Framingham Offspring Study participants, and measured femoral neck (FN) and lumbar spine (LS) BMD 2 to 10 years later using dual-energy X-ray absorptiometry. We assessed osteoporotic fractures up to 27-year follow-up after metabolomic profiling. We identified 27 metabolites associated with FN-BMD or LS-BMD by LASSO regression with internal validation. Incorporating selected metabolites significantly improved the prediction and the classification of osteoporotic fracture risk beyond conventional risk factors (area under the curve [AUC] = 0.74 for the model with identified metabolites and risk factors versus AUC = 0.70 with risk factors alone, p = .001; net reclassification index = 0.07, p = .03). We replicated significant improvement in fracture prediction by incorporating selected metabolites in 634 participants from the Hong Kong Osteoporosis Study (HKOS). The glycine, serine, and threonine metabolism pathway (including four identified metabolites: creatine, dimethylglycine, glycine, and serine) was significantly enriched (false discovery rate [FDR] p value = .028). Furthermore, three causally related metabolites (glycine, phosphatidylcholine [PC], and triacylglycerol [TAG]) were negatively associated with FN-BMD, whereas PC and TAG were negatively associated with LS-BMD through Mendelian randomization analysis. In summary, metabolites associated with BMD are helpful in osteoporotic fracture risk prediction. Potential causal mechanisms explaining the three metabolites on BMD are worthy of further experimental validation. Our findings may provide novel insights into the pathogenesis of osteoporosis. © 2021 American Society for Bone and Mineral Research (ASBMR). 相似文献
106.
Jarred Kaiser Brett Allaire Paul M Fein Darlene Lu Alexander Adams Douglas P Kiel Mohamed Jarraya Ali Guermazi Serkalem Demissie Elizabeth J Samelson Mary L Bouxsein Elise F Morgan 《Journal of bone and mineral research》2020,35(4):641-648
The spatial heterogeneity in trabecular bone density within the vertebral centrum is associated with vertebral strength and could explain why volumetric bone mineral density (vBMD) exhibits low sensitivity in identifying fracture risk. This study evaluated whether the heterogeneity and spatial distribution of trabecular vBMD are associated with prevalent vertebral fracture. We examined the volumetric quantitative computed tomography (QCT) scans of the L3 vertebra in 148 participants in the Framingham Heart Study Multidetector CT study. Of these individuals, 37 were identified as cases of prevalent fracture, and 111 were controls, matched on sex and age with three controls per case. vBMD was calculated within 5-mm contiguous cubic regions of the centrum. Two measures of heterogeneity were calculated: (i) interquartile range (IQR); and (ii) quartile coefficient of variation (QCV). Ratios in the spatial distributions of the trabecular vBMD were also calculated: anterior/posterior, central/outer, superior/mid-transverse, and inferior/mid-transverse. Heterogeneity and spatial distributions were compared between cases and controls using Wilcoxon rank sum tests and t tests and tested for association with prevalent fractures with conditional logistic regressions independent of integral vBMD. Prevalent fracture cases had lower mean ± SD integral vBMD (134 ± 38 versus165 ± 42 mg/cm3, p < .001), higher QCV (0.22 ± 0.13 versus 0.17 ± 0.09, p = .003), and lower anterior/posterior rBMD (0.65 ± 0.13 versus 0.78 ± 0.16, p < .001) than controls. QCV was positively associated with increased odds of prevalent fracture (OR 1.61; 95% CI, 1.04 to 2.49; p = .034), but this association was not independent of integral vBMD (p = .598). Increased anterior/posterior trabecular vBMD ratio was associated with decreased odds of prevalent fracture independent of integral vBMD (OR 0.38; 95% CI, 0.20 to 0.71; p = .003). In conclusion, increased trabecular vBMD in the anterior versus posterior centrum, but not trabecular vBMD heterogeneity, was associated with decreased risk of prevalent fracture independent of integral vBMD. Regional measurements of trabecular vBMD could aid in determining the risk and underlying mechanisms of vertebral fracture. © 2019 American Society for Bone and Mineral Research. 相似文献
107.
《Neurological research》2013,35(5):455-462
AbstractDetermination of relevant clinical monitoring parameters for helping guide the intensive care therapy in patients with severe head injury, is one of the most demanding issues in neurotrauma research. New insights into cerebral autoregulation and metabolism have revealed that a rigid cerebral perfusion pressure (CPP) regimen might not be suitable for all severe head injured patients. We thus developed an online analysis technique to monitor the correlation (AIρ) between the spontaneous fluctuations of the mean arterial blood pressure (MABP) and the intracranial pressure (ICP). In addition, brain tissue oxygen (PtiO2) and metabolic microdialysate measures including glucose and lactate were registered. We found that in patients with good outcome, the AIρ values were significantly lower as compared with patients with poor outcome. Accordingly, microdialysate glucose and lactate were significantly higher in the good outcome group. We conclude that online determination of AIρ offers a valuable additional and technically easily performable tool for guidance of therapy in patients with severe head injury. 相似文献
108.
Claudia Beaudoin Sonia Jean Lynne Moore Philippe Gamache Louis Bessette Louis-Georges Ste-Marie Jacques P. Brown 《Journal of bone and mineral research》2021,36(12):2329-2342
In Canada and other countries, osteoporosis is monitored as part of chronic disease population surveillance programs. Although fractures are the principal manifestation of osteoporosis, very few algorithms are available to identify individuals at high risk of osteoporotic fractures in current surveillance systems. The objective of this study was to derive and validate predictive models to accurately identify individuals at high risk of osteoporotic fracture using information available in healthcare administrative data. More than 270,000 men and women aged ≥66 years were randomly selected from the Quebec Integrated Chronic Disease Surveillance System. Selected individuals were followed between fiscal years 2006–2007 and 2015–2016. Models were constructed for prediction of hip/femur and major osteoporotic fractures for follow-up periods of 5 and 10 years. A total of 62 potential predictors measurable in healthcare administrative databases were identified. Predictor selection was performed using a manual backward algorithm. The predictive performance of the final models was assessed using measures of discrimination, calibration, and overall performance. Between 20 and 25 predictors were retained in the final prediction models (eg, age, sex, social deprivation index, most of the major and minor risk factors for osteoporosis, diabetes, Parkinson's disease, cognitive impairment, anemia, anxio-depressive disorders). Discrimination of the final models was higher for the prediction of hip/femur fracture than major osteoporotic fracture and higher for prediction for a 5-year than a 10-year period (hip/femur fracture for 5 years: c-index = 0.77; major osteoporotic fracture for 5 years: c-index = 0.71; hip/femur fracture for 10 years: c-index = 0.73; major osteoporotic fracture for 10 years: c-index = 0.68). The predicted probabilities globally agreed with the observed probabilities. In conclusion, the derived models had adequate predictive performance in internal validation. As a final step, these models should be validated in an external cohort and used to develop indicators for surveillance of osteoporosis. © 2021 American Society for Bone and Mineral Research (ASBMR). 相似文献
109.
Thomas Merlijn Karin MA Swart Natasja M van Schoor Martijn W Heymans Babette C van der Zwaard Amber A van der Heijden Femke Rutters Paul Lips Henriëtte E van der Horst Christy Niemeijer J Coen Netelenbos Petra JM Elders 《Journal of bone and mineral research》2019,34(11):1993-2000
Population screening for fracture risk may reduce the fracture incidence. In this randomized pragmatic trial, the SALT Osteoporosis Study (SOS), we studied whether screening for fracture risk and subsequent treatment in primary care can reduce fractures compared with usual care. A total of 11,032 women aged 65 to 90 years with ≥1 clinical risk factor for fractures were individually randomized to screening (n = 5575) or usual care (n = 5457). Participants in the screening group underwent a screening program, including bone densitometry and vertebral fracture assessment. Participants with a high 10-year fracture probability (FRAX) or a vertebral fracture were offered treatment with anti-osteoporosis medication by their general practitioner. Incident fractures as reported by questionnaires were verified with medical records. Follow-up was completed by 94% of the participants (mean follow-up = 3.7 years). Of the 5575 participants in the screening group, 1417 (25.4%) had an indication for anti-osteoporosis medication. Screening and subsequent treatment had no statistically significant effect on the primary outcome fracture (hazard ratio [HR] = 0.97; 95% confidence interval [CI] 0.87–1.08), nor on the secondary outcomes osteoporotic fractures (HR = 0.91; 95% CI 0.81–1.03), major osteoporotic fractures (HR = 0.91; 95% CI 0.80–1.04), hip fractures (HR = 0.91; 95% CI 0.71–1.15), falls (odds ratio [OR] = 0.91; 95% CI 0.72–1.15), or mortality (HR = 1.03; 95% CI 0.91–1.17). Post hoc explorative finding suggested that screening might be most effective after a recent fracture (HR = 0.65; 95% CI 0.44–0.96 for major osteoporotic fractures and HR = 0.38; 95% CI 0.18–0.79 for hip fractures). The results of this study might have been compromised by nonparticipation and medication nonadherence in the screening group. Overall, this study does not provide sufficient indications to consider screening for fracture prevention. However, we cannot exclude its clinical relevance to reduce (major) osteoporotic fractures and hip fractures because of the relatively small number of women with a treatment indication in the intervention group. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc. 相似文献
110.
Background: Roux-en-Y gastric bypass (RYGBP) is the preferred operation for the treatment of morbid obesity by many surgeons.
Hereby we present the process by which laparoscopic RYGBP (LRYGBP) developed at our institution. Methods: Perioperative morbidity
was recorded from 150 consecutive morbidly obese patients operated upon by RYGBP from August 1994 to March 2002. The first
76 consecutive patients have been followed up to 5 years postoperatively. A subgroup of 40 patients was recruited to evaluate
the postoperative lung function in a randomized study between receiving and not receiving prophylactic chest physiotherapy.
Results: In the whole series, there were 4 conversions to open surgery, 5 leaks, 12 postoperative bleedings and 1 intestinal
obstruction. 1 patient succumbed after developing acute dilatation of the bypassed stomach. Respiratory function deteriorated
significantly in all patients in the early postoperative period, irrespective if given physiotherapy. During the follow-up
period, 3 patients developed mechanical obstruction of the Roux limb. Another patient had a perforated ulcer at the proximal
pouch. Weight reduction averaged 70% of excess body weight at 2 years after surgery. Conclusions: LRYGBP is an effective treatment
for morbid obesity. During the initial development, we experienced a number of serious complications. The complication rate
decreased over time. Postoperative lung function was markedly impaired, but there were no beneficial effects of chest physiotherapy.
Long-term weight loss after LRYGBP seems to be comparable to what has been reported after open RYGBP. 相似文献