Changes in bone microarchitecture following kidney transplantation—Beyond bone mineral density

Bone disease in kidney transplant recipients (KTRs) is characterized by bone mineral density (BMD) loss but bone microarchitecture changes are poorly defined. In this prospective cohort study, we evaluated bone microarchitecture using non‐invasive imaging modalities; high‐resolution magnetic resonance imaging (MRI), peripheral quantitative computed tomography (pQCT), dual energy X‐ray absorptiometry (DXA), and the trabecular bone score (TBS) following kidney transplantation. Eleven KTRs (48.3 ± 11.2 years) underwent MRI (tibia), pQCT (radius) and DXA at baseline and 12 months post–transplantation. Transiliac bone biopsies, performed at transplantation, showed 70% of patients with high/normal bone turnover. Compared with baseline, 12‐month MRI showed deterioration in indices of trabecular network integrity—surface to curve ratio (S/C; ?15%, P = 0.03) and erosion index (EI; +19%, P = 0.01). However, cortical area increased (+10.3%, P = 0.04), with a non‐significant increase in cortical thickness (CtTh; +7.8%, P = 0.06). At 12 months, parathyroid hormone values (median 10.7 pmol/L) correlated with improved S/C (r = 0.75, P = 0.009) and EI (r = ?0.71, P = 0.01) while osteocalcin correlated with CtTh (r = 0.72, P = 0.02) and area (r = 0.70, P = 0.02). TBS decreased from baseline (?5.1%, P = 0.01) with no significant changes in BMD or pQCT. These findings highlight a post–transplant deterioration in trabecular bone quality detected by MRI and TBS, independent of changes in BMD, underlining the potential utility of these modalities in evaluating bone microarchitecture in KTRs.     

Early developmental conditions affect stress response in juvenile but not in adult house sparrows (Passer domesticus)

The short- and long-term consequences of developmental conditions on fitness have received growing attention because the environmental conditions during early life may influence growth, condition at independence, recruitment, reproductive success or survival. We tested here, in a natural house sparrow population, if early conditions during nestling stage affected the stress response of the birds (i) shortly after fledging and (ii) next year, during their first breeding. We experimentally manipulated brood size to mimic different rearing conditions, creating reduced (−2 chicks) and enlarged broods (+2 chicks), while in a third group brood size was not manipulated. Nestling nutrition state decreased with post-manipulation brood sizes as indicated by lower body mass. Fledglings with higher body mass at the age of ten days showed lower stress response than birds that were leaner at the same age. Fledglings reared in large broods showed a higher response to stress protocol than chicks from small broods, and this effect was in significant interaction with the age of fledglings at capture. This interaction indicates that the effects of the brood size became gradually smaller as the fledglings grew older and were further from their nestling period. The effects of early conditions vanished by the next year: the stress response of adult first time breeders was unrelated to the brood size they fledged from. These results suggest that stress response may reflect the actual state of an individual, rather than its developmental history.     

18F-sodium fluoride PET/CT provides prognostic clarity compared to calcium and Framingham risk scoring when addressing whole-heart arterial calcification

European Journal of Nuclear Medicine and Molecular Imaging - To investigate the benefit of utilizing 18F-sodium fluoride (NaF) PET/CT over calcium and Framingham scoring for potential preventative...     

Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior

BACKGROUND: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. METHODS: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. RESULTS: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the Ia group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. LIMITATIONS: Long-term data are needed to assess the stability of these groups. CONCLUSIONS: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.     

The use of [125I]deoxyuridine for semi-microevaluation of human lymphocyte response to phytohemagglutinin in vitro

[125I]5-iodo-2'-deoxyuridine ([125I]UdR) was compared with [6-3H]thymidine ([3H]TdR) in a semi-micromethod used to evaluate the response of human lymphocytes to phytohemagglutinin (PHA) in vitro. 5-Fluoro-2'-dexoyuridine (FUdR) was added to [125I]UdR in order to increase its incorporation, by preventing endogenous thymidine synthesis. The relationship between PHA concentration and the isotope uptake by lymphocytes was studied. Similar dose-response curves were found for the two precursors, with a peak at 15 microgram/ml of PHA. Nevertheless the recovery of the labeled compounds was higher when [125I]UdR together with FUdR was used.     

Influence of a brushing working motion on the fatigue life of NiTi rotary instruments

AIM: To evaluate the cyclic fatigue resistance of Mtwo NiTi rotary instruments when used with a brushing or no-brushing action in oval root canals. METHODOLOGY: Cyclic fatigue testing of instruments was performed in tapered artificial canals with a 5 mm radius of curvature and an angle of curvature of 60 degrees. Twenty Mtwo instruments for each size were selected and divided into two groups: group A = 10 instruments used with a no-brushing motion (control group); group B = 10 instruments used with a brushing-milling action. Each Mtwo instrument was used for cleaning and shaping 10 oval root canals. In all 80 instruments were rotated until fracture occurred and the number of cycles to failure (NCF) recorded. Data were analysed by one-way ANOVA, Tukey HSD test and independent sample t-test to determine any statistical difference; the significance was determined at the 95% confidence level. RESULTS: No statistically significant reduction of NCF between instruments used with a no-brushing motion (group A) and instruments used with a brushing motion (group B) were apparent except for size 25, 0.06 taper. Mtwo size 10, 0.04 taper, size 15, 0.05 taper, size 20, 0.06 taper, size 25, 0.06 taper instruments had a decrease in life span of 1%, 0.5%, 8% and 19%, respectively. CONCLUSIONS: Fatigue life of instruments of larger size could be reduced by using them with a lateral brushing or pressing movement. However, each file was successfully operated without intracanal failure, demonstrating that Mtwo rotary instruments can be used safely in a brushing action in simulated clinical conditions up to 10 times in oval canals.     

Psychological factors of genital automutilation and medico-ethical interest in emergency vulvoplasty

The genital self-mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.