Osteoporosis is a common skeletal disorder characterized by low bone mass, which leads to reduced bone strength and an increased risk of fractures. Anabolic agents have been shown to improve bone ...mass and decrease fracture risk in osteoporosis patients by directly stimulating osteoblasts to produce new bone. Currently, two anabolic agents are available in the USA: recombinantly produced teriparatide (TPTD), which is the fully active (1–34) amino active sequence of human parathyroid hormone (PTH), and abaloparatide (APTD), a synthetic analog of parathyroid hormone-related peptide (PTHrP). At present, both agents are approved only for treatment of patients with osteoporosis at high risk of fracture. Nonetheless, their anabolic properties have led to off-label application in additional settings which include spine fusion, osteonecrosis of the jaw, arthroplasty, and fracture healing. In this article, we summarize available scientific literature regarding the efficacy, effectiveness, and safety of TPTD in these off-label settings.
Summary
Pelvic fracture patients were randomized to blinded daily subcutaneous teriparatide (TPTD) or placebo to assess healing and functional outcomes over 3 months. With TPTD, there was no evidence ...of improved healing by CT or pain reduction; however, physical performance improved with TPTD but not placebo (group difference
p
< 0.03).
Introduction
To determine if teriparatide (20 μg/day; TPTD) results in improved radiologic healing, reduced pain, and improved functional outcome vs placebo over 3 months in pelvic fracture patients.
Methods
This randomized, placebo-controlled study enrolled 35 patients (women and men
>
50 years old) within 4 weeks of pelvic fracture and evaluated the effect of blinded TPTD vs placebo over 3 months on fracture healing. Fracture healing from CT images at 0 and 3 months was assessed as cortical bridging using a 5-point scale. The numeric rating scale (NRS) for pain was administered monthly. Physical performance was assessed monthly by Continuous Summary Physical Performance Score (based on 4 m walk speed, timed repeated chair stands, and balance) and the Timed Up and Go (TUG) test.
Results
The mean age was 82, and >80% were female. The intention to treat analysis showed no group difference in cortical bridging score, and 50% of fractures in TPTD-treated and 53% of fractures in placebo-treated patients were healed at 3 months, unchanged after adjustment for age, sacral fracture, and fracture displacement. Median pain score dropped significantly in both groups with no group differences. Both CSPPS and TUG improved in the teriparatide group, whereas there was no improvement in the placebo group (group difference
p
< 0.03 for CSPPS at 2 and 3 months).
Conclusion
In this small randomized, blinded study, there was no improvement in radiographic healing (CT at 3 months) or pain with TPTD vs placebo; however, there was improved physical performance in TPTD-treated subjects that was not evident in the placebo group.
The inverse phase transfer process of catalytic benzoylation of α-amino acids (on the example of alanine) in a two-phase water–dichloromethane system in the presence of pyridine derivatives as ...catalysts is investigated. The effect of the initial concentration of alanine, its form in solution, and the initial catalyst concentration on the reaction rate and the composition of the products is studied. It is established that using 4-methyl- and 4-methoxy pyridine N-oxides combined with a double excess of the sodium salt of alanine makes it possible to obtain 2-benzamidopropionic acid with a yield of more than 80%.
Corrosion behavior of matte and bright galvanic nickel coatings in solutions and vapor of acetic acid are studied. Corrosion of the corresponding materials in the studied media occurs with oxygen ...depolarization. The rate of anodic dissolution of bright nickel deposits in acetic acid solutions is higher than that of matte ones, due to the effect of sulfur on the continuity of the passive film on bright nickel deposits and their ability to passivation. Based on EDX and XRD studies, the formation of corrosion products on the surface of bright nickel deposits in the form of nickel acetate and a film of nickel sulfides of variable stoichiometric composition during the exposure in acetic acid solutions and vapor are shown. The stoichiometric composition of sulfide corrosion products changes with increasing sulfur content from Ni
3
S
2
to Ni
3
S
4
under prolonged exposure of the studied bright nickel deposits in vapor or solutions of acetic acid.
Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with ...decreased risk of delirium through postoperative day 3.
This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural. As a secondary outcome, all delirium assessments were then longitudinally analyzed in relation to epidural use throughout the follow-up period. Given the potential relevance to delirium, postoperative pain, opioid consumption, sleep disturbances, and symptoms of depression were also analyzed as secondary outcomes. A semiparsimonious multivariable logistic regression model was used to test the association between postoperative epidural use and delirium incidence, and generalized estimating equations were used to test associations with secondary outcomes described. Models included relevant covariates to adjust for confounding.
In total, 263 patients were included for analysis. Epidural use was not independently associated with reduced delirium incidence (adjusted odds ratio, 0.65 95% CI, 0.32-1.35; P = .247). However, when analyzing all assessments over the follow-up period, epidural patients were 64% less likely to experience an episode of delirium (adjusted odds ratio, 0.36 95% CI, 0.17-0.78; P = .009). Adjusted pain scores (visual analog scale, 0-100 mm) were significantly lower in the epidural group on postoperative day 1 (morning, -16 95% CI, -26 to -7, P < .001; afternoon, -15 95% CI, -25 to -5, P < .01) and postoperative day 3 (morning, -13 95% CI, -20 to -5, P < .01). Adjusted mean oral and IV morphine equivalents were also significantly lower on postoperative day 1 in the epidural group (74% lower 95% CI, 55%-85%; P < .0001). Finally, postoperative epidural use was not significantly associated with new sleep disturbances or changes in depression symptoms.
Postoperative epidural use was not associated with a reduced overall incidence of delirium. However, longitudinal analysis revealed reduced adjusted odds of experiencing an episode of delirium in the epidural group. Epidural use was also associated with reduced postoperative pain and opioid consumption. An appropriately designed follow-up study is warranted to further analyze the relationship among epidural use, postoperative delirium, and related outcomes.
The effect of electron irradiation on the evolution of photoluminescence and optical properties of Si-doped GaN was investigated. MOCVD grown GaN thin films were irradiated with 4 MeV electrons at ...different doses of 1·107, 2.5·107 and 1·108 rad. It was obtained that room temperature photoluminescence as well as transmittance spectra of irradiated samples changed during long-term period after treatment. The low dose effect was observed at 107 rad. Radiation memory effect was detected. Long-term modification model based on the idea of defect diffusion is proposed. Diffusion factors of migrating components are estimated. Irradiation induced effects on the defect subsystem of gallium nitride are discussed.
•The radiation “memory effect” in GaN was detected by photoluminescence and optical measurements.•Existed model of defect creation due to the electron irradiation was confirmed.•The recovery properties during some time after irradiation were detected.•The conception of defect diffusion was proposed to explain observed features.•Diffusion factors of migrated defects are estimated.
The adsorption of phenol by activated carbons obtained by the alkaline thermolysis (KOH, 800°C) of fossil coals of various degrees of metamorphism (C
daf
= 70.4–95.6%) was studied. Kinetic ...dependences and adsorption isotherms were obtained at initial concentrations of ≤3 mg/cm
3
(25°C). The rate constants of absorption of the adsorbate, maximum and specific capacities for phenol, and their dependences on C
daf
were determined. The main processes of the interaction of phenol with surface adsorption centers are discussed.
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