Should Future Risk-of-Fracture Analyses Include Another Major Risk Factor? The Case for Falls

This article proposes two things. (i) The major risk of so-called osteoporotic fractures that affect extremity bones (hips, wrists, etc.) consists of falls. Impairments of balance, vision, muscle strength, and neuromuscular coordination increase falls in aging adults, and when an osteopenia coexists, that makes such fractures more likely than otherwise. (ii.) Risk-of-fracture studies should separate patients who develop fractures from falls or injuries, from patients in whom fractures occur spontaneously, meaning during ordinary voluntary physical activities instead of from any kind of trauma.     

Therapeutic evaluation of UVB‐targeted phototherapy in vitiligo that affects less than 10% of the body surface area*

Background Current treatments for vitiligo include different therapeutic modalities, such as corticosteroids, immunomodulators, pseudocatalase, skin grafts, diverse types of phototherapy [ultraviolet B (UVB), psoralen plus UVA (PUVA), narrow‐band UVB (NB‐UVB)], and, recently, targeted phototherapy. After a literature search, we found only two studies using different targeted broad‐band UVB units for the treatment of vitiligo. Objective To evaluate the repigmentation response induced with broad‐band, UVB‐targeted phototherapy used as monotherapy in patients with vitiligo affecting less than 10% of the skin surface. Methods Twelve patients were recruited for treatment with 30 sessions of UVB‐targeted phototherapy administered twice weekly. The assessment of repigmentation was made from a comparison of baseline photographs with those after 30 sessions by two independent investigators. Morphometric analysis was performed using a computer program. Results Repigmentation with an average of 66.25% was obtained on lesions of the face, and of 31.5% on the neck, trunk, and genitalia. On the extremities, there was no repigmentation. Itching, a burning sensation, erythema, desquamation, and transitory hyperpigmentation were observed in some patients. Minimal blistering and ulceration were observed in one patient. Conclusion Targeted UVB phototherapy seems to be effective for the repigmentation of vitiligo in lesions located on the face, to a lesser degree on the trunk, and with no response in acral lesions; there were minimal adverse effects that did not require discontinuation of treatment.     

Randomized comparison of endothelial progenitor cells capture stent versus cobalt‐chromium stent for treatment of ST‐elevation myocardial infarction. Six‐month clinical,angiographic, and IVUS follow‐up

Purpose : The aim of this trial was to assess the feasibility and safety of endothelial progenitor cells capture (EPC) stent in the treatment of acute ST‐elevation myocardial infarction (STEMI) when compared with cobalt‐chromium stents (CoCr). Methods : Between July 2006 and May 2008, 100 patients with single vessel disease undergoing primary PCI for STEMI were randomly assigned to receive either EPC stent (N = 50) or CoCr stent (N = 50). High‐pressure stent implantation was carried out in both groups. Dual antiplatelet treatment was administered for 30 days in both groups. All patients underwent 6‐month clinical, angiographic, and IVUS follow‐up. Results : The rate of major adverse cardiovascular events (MACEs) at 30 days was comparable in both groups. At 6‐month follow‐up, the rates of MACEs and TLR in the EPC stent group when compared with CoCr stent were 24% vs.10%; P = 0.06 and 14% vs. 4%; P = 0.08, respectively. There were three cases (6%) of stent thrombosis (ST) in the EPC stent group versus none in CoCr group. Conclusion : The use of EPC capture stents in the setting of STEMI is feasible and safe in terms of 30‐days outcome. However, at the 6‐month follow‐up, we found a trend of higher rates of MACE and TLR in the EPC stent capture group compared to CoCr stents. The study does not support the use of EPC capture stents with short duration dual antiplatelet therapy in patients with STEMI. Future randomized studies with large sample sizes would be necessary to demonstrate the safety of such approach. © 2010 Wiley‐Liss, Inc.