Summary
Patients with chronic kidney disease have high risk of osteoporotic fractures. Lower trabecular bone score (TBS) was associated with poorer kidney function and higher fracture risk when ...kidney function was normal. Addition of TBS to The Fracture Risk Assessment Tool with bone mineral density did not improve fracture risk prediction.
Introduction
We sought to determine whether trabecular bone score (TBS) either independently or adjusted for The Fracture Risk Assessment Tool (FRAX) could predict risk of major osteoporotic fractures (MOFs) in a large population-based sample of patients with all stages of chronic kidney disease (CKD).
Methods
We used population-based administrative databases to identify patients above age 20 years who had dual-energy X-ray absorptiometry (DXA) scan and serum creatinine measured within 1 year, during the years 2005 to 2010. Patients were excluded if they were on dialysis or had a functioning renal transplant. We stratified patients by estimated glomerular filtration rate (eGFR). We collected femoral neck bone mineral density (BMD), lumbar spine TBS, incident major osteoporotic fractures (MOF) and hip fractures, and other clinical characteristics.
Results
Among 8289 patients, there were 6224 (75.1%) with eGFR ≥ 60 mL/min/1.73 m
2
, 1624 (19.6%) with eGFR 30–60 mL/min/1.73 m
2
, and 441 (5.3%) with eGFR < 30 mL/min/1.73 m
2
. There were 593 patients (7.2%) with MOFs and 163 (2.0%) with hip fractures. Lower TBS score was associated with increased risk of MOF and hip fractures across all eGFR strata in unadjusted Cox proportional hazards models but after adjusting for FRAX with BMD, lower TBS was only statistically significant for MOF prediction for eGFR ≥ 60 mL/min/1.73 m
2
.
Conclusion
Lower TBS scores were associated with lower eGFR and increased fracture risk in patients with eGFR ≥ 60 mL/min/1.73 m
2
. However, the addition of TBS to the FRAX score with BMD did not significantly improve fracture risk prediction in patients with CKD.
Taboo or not taboo? C. Bohm, Lori; Curtis, Rebecca C; Willock, Brent
2009., 2009, 20180329, 2009-12-31
eBook
This book challenges this idea by examining a sampling of the taboos that are rife in the field. It is not intended to offer a complete summary of all of the forbidden ideas, clinical procedures, ...behaviors and institutional practices in psychoanalysis, but rather to raise consciousness about the fact that even within a field which encourages freedom of expression, many issues remain difficult to fully discuss both in the consulting room and in professional discourse.
The NNBAR experiment for the European Spallation Source will search for free neutrons converting to antineutrons with an expected sensitivity improvement of three orders of magnitude compared to the ...last such search. This paper describes both the simulations of a key component for the experiment, the neutron optical reflector and the expected gains in sensitivity.
Inherited variants in multiple different genes are associated with increased risk for Alzheimer's disease (AD). In many of these genes, the inherited variants alter some aspect of the production or ...clearance of the neurotoxic amyloid β-peptide (Aβ). Thus missense, splice site or duplication mutants in the presenilin 1 (PS1), presenilin 2 (PS2) or the amyloid precursor protein (APP) genes, which alter the levels or shift the balance of Aβ produced, are associated with rare, highly penetrant autosomal dominant forms of Familial Alzheimer's Disease (FAD). Similarly, the more prevalent late-onset forms of AD are associated with both coding and non-coding variants in genes such as SORL1, PICALM and ABCA7 that affect the production and clearance of Aβ. This review summarises some of the recent molecular and structural work on the role of these genes and the proteins coded by them in the biology of Aβ. We also briefly outline how the emerging knowledge about the pathways involved in Aβ generation and clearance can be potentially targeted therapeutically. This article is part of Special Issue entitled "Neuronal Protein".
•Rare, medium and common variants in at least 20 genes are associated with AD.•Multiple genes affect processing of APP and production of Aβ peptide.•Others relate to immunity, inflammation, vesicular trafficking, and lipid metabolism.•These genes reflect steps in a complex metabolic/signalling cascade.•Nodal points in these pathways may represent potential therapeutic targets.
Objectives Acute lower limb ischaemia (ALLI) is a potentially fatal, limb threatening medical emergency. Early treatment is essential for a good outcome. The aim was to describe the early chain of ...care in ALLI focusing on lead times and emergency management in order to identify weak links for improvement. Methods This was a retrospective, descriptive case study. This study analysed the medical records of all patients with a main discharge diagnosis of ALLI between January 2009 and December 2014. Predetermined emergency care data on lead times, diagnosis recognition, presenting symptoms, emergency care treatment and outcome were collected for patients who were transported by the Emergency Medical Service (EMS) and those who were not. Results In total, 552 medical records were audited of which 195 patients fulfilled the inclusion criteria and were analysed. Among them were 117 (60%) transported by the EMS. The median time from symptom onset to revascularisation was 23 (interquartile range IQR 10–55; EMS transported) and 93 (IQR 42–152, not EMS transported) hours ( p < .01). The time from symptom onset to arrival in hospital was 5 (IQR 2–26; EMS transported) and 48 (IQR 6–108; not EMS transported) hours. After arrival in hospital, the median time to first doctor evaluation was 51 (IQR 28–90; EMS transported) and 80 (IQR 44–169; not EMS transported) minutes, p = .01. Low molecular weight heparin (LMWH) was given to 72% of patients in the emergency department (ED) and a multivariate analysis showed that the use of LMWH was associated with a more favourable outcome. Conclusions Both the time spent in the ED and the time from the onset of symptoms to revascularisation were considerably longer than optimal. Time delays in the early treatment chain can mainly be attributed to “patient delay” and a considerable time spent in hospital before revascularisation. The use of LMWH as an integral part of ED management was associated with a better outcome.
We introduce an analytical model to rapidly determine the thermal conductivity reduction due to mass disorder in nanomaterials. Although this simplified classical model depends only on the masses of ...the different atoms, it adequately describes the changes in thermal transport as the concentrations of these atoms vary. Its predictions compare satisfactorily with nonequilibrium molecular dynamics simulations of the thermal conductivity of (14)C-(12)C carbon nanotubes as well as with previous simulations of other materials. We present it as a simple tool to quantitatively estimate the thermal conductivity decrease that is induced by isotope substitution in various materials.
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