C-reactive protein predicts incident fracture in community-dwelling elderly Japanese women: the Muramatsu study

SUMMARY

In a 6-year cohort study of 751 community-dwelling elderly Japanese women, we found that C-reactive protein (CRP) is a significant predictor of osteoporotic fracture in elderly Asian women, who have significantly lower CRP levels than Caucasians. Mechanisms explaining such an association should be further studied.

INTRODUCTION

While CRP, a systemic inflammation marker, is thought to be associated with osteoporosis, evidence supporting this claim has been limited. We aimed to assess the association between CRP levels and incident osteoporotic fracture in elderly women.

METHODS

We conducted a cohort study with a follow-up period of 6 years. The study included 751 Japanese women aged 69 years or older. We measured serum high-sensitivity CRP (hs-CRP) levels as a major predictor. Covariates included age, body mass index, forearm bone mineral density, calcium intake, serum 25-hydroxyvitamin D, postural sway, osteoporosis medication, and physical activity. The primary outcome was incident limb and vertebral fractures. The Cox proportional hazards model was used to calculate the hazard ratio (HR) of fracture.

RESULTS

Median hs-CRP values in study participants were 0.16 mg/L in the lowest tertile, 0.36 mg/L in the medium tertile, and 1.14 mg/L in the highest tertile. The hs-CRP values in these women were substantially lower than in their Caucasian counterparts. Limb or vertebral fractures occurred in 50 subjects during 4,250 person-years. Low CRP levels were associated with low incidence of limb or vertebral fractures (P for trend = 0.035). The adjusted HRs of fracture for the medium and highest quartiles of hs-CRP levels, compared to the lowest quartile, were 2.22 (95% CI, 1.02-4.84) and 2.40 (95% CI, 1.10-5.24), respectively.

CONCLUSIONS

CRP is a significant predictor of osteoporotic fracture in elderly Asian women who have substantially lower CRP levels than Caucasians. Mechanisms explaining such an association should be further studied.

Microstructure and Texture of Electroplated Copper in Damascene Structures

The transition from Al to Cu for advanced ULSI interconnects involves changes in architecture and deposition technique that will influence the microstructure and texture of the metal. Cu interconnects are typically formed within the confines of pre-patterned trenches and vias using an electroplating process with a sputtered Cu conduction layer deposited over a refractory metalbased diffusion barrier layer. In this paper, we focus on the influence of the barrier layer (PVD Ti/TiN, Ta, TaN, CVD TiN) and the effect of a vacuum break between barrier and conduction layer depositions, on the texture of the Cu lines, as examined by X-ray diffraction pole figure analysis.

A preferred (111) orientation was observed for all samples. The samples with no vacuum break between barrier and conduction layer deposition exhibited in plane anisotropy that was particularly pronounced for the Ta and TaN samples compared with the Ti/TiN sample. Focused ion beam images and transmission electron micrographs showed Cu grain size to be on the order of the trench width with a high degree of twinning, and no boundary could be distinguished between the PVD Cu conduction layer and the electroplated Cu.

Vitamin D sufficiency is associated with low incidence of limb and vertebral fractures in community-dwelling elderly Japanese women: the Muramatsu Study

Data on the association between vitamin D status and osteoporotic fracture in Asians are sparse. We conducted a 6-year cohort study of 773 community-dwelling elderly Japanese women and found that serum 25-hydroxyvitamin D (25(OH)D) ≥ 71 nmol/L was associated with a reduced risk of osteoporotic limb and vertebral fractures.

INTRODUCTION

Data on the association between vitamin D status and osteoporotic fracture in Asians are sparse. This study aimed to clarify the association between vitamin D and other markers of nutritional status with the incidence of fracture in elderly Japanese women.

METHODS

We conducted a cohort study with a 6-year follow-up of 773 community-dwelling women aged 69 years and older. The 6-year follow-up ended in 2009. We assessed serum 25-hydroxyvitamin D, undercarboxylated osteocalcin (an index of vitamin K status), and calcium intake. The primary outcome was incident limb and vertebral fractures. Covariates were forearm bone mineral density (BMD), age, body mass index, osteoporosis treatment, and physical activity.

RESULTS

The mean serum 25(OH)D concentration was 60.0 nmol/L. Thirty-seven limb fractures and 14 vertebral fractures occurred in 4,392 person-years. Lower forearm BMD was significantly associated with increased incident fracture (P = 0.0242). The adjusted hazard ratios (HR) of fracture for the first quartile (<47.7 nmol/L) and the third quartile (59.2-70.9 nmol/L) of serum 25(OH)D, compared to the fourth quartile (≥71.0 nmol/L), were 2.82 (95% confidence interval (CI), 1.09-7.34) and 2.82 (95%CI, 1.09-7.27), respectively. The pooled adjusted HR was 0.42 (95%CI, 0.18-0.99) when the incidence in the fourth quartile (≥71.0 nmol/L) was compared to the other three quartiles combined (<71.0 nmol/L). Vitamin K status and calcium intake were not associated with incident fracture.

CONCLUSIONS

Sufficient vitamin D status, i.e., serum 25(OH)D ≥ 71 nmol/L, is associated with low limb and vertebral fracture risk in community-dwelling elderly women.

Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome

The outcome and cause of death of each lung disease directly associated with rheumatoid arthritis (RA-LD) have been poorly investigated. A retrospective study was conducted of 144 patients with RA-LD, in whom the median follow-up period after the initial visit for a respiratory examination was 4.5 yrs. A total of 57 patients were identified with usual interstitial pneumonia (UIP), 31 with bronchiectasis, 16 with nonspecific interstitial pneumonia (NSIP), 11 with bronchiolitis, five with organising pneumonia (OP), five with diffuse alveolar damage (DAD) and 19 with combined disease. The 5-yr survival rates were 36.6% in the UIP group, 87.1% in the bronchiectasis group, 93.8% in the NSIP group, 88.9% in the bronchiolitis group, 60.0% in the OP group and 20.0% in the DAD group. Survival of patients with DAD was worse than that of patients with UIP. Overall, survival of patients with UIP was worse than that of patients with bronchiectasis, NSIP or bronchiolitis. Of the 144 patients, 71 (49.3%) died, of whom 58 (81.7%) died due to respiratory lesions. Of patients with RA-LD, patients with DAD experienced the highest mortality, and the survival of patients with UIP was worse than that of patients with NSIP.

Prior nonhip limb fracture predicts subsequent hip fracture in institutionalized elderly people

SUMMARY

This 1-year cohort study of nursing home residents revealed that historical fractures of upper limbs or nonhip lower limbs were associated with hip fracture (hazard ratio = 2.14), independent of activities of daily living (ADL), mobility, dementia, weight, and type of nursing home. Prior nonhip fractures are useful for predicting of hip fracture in institutional settings.

INTRODUCTION

The aim of this study was to evaluate the utility of fracture history for the prediction of hip fracture in nursing home residents.

METHODS

This was a cohort study with a 1-year follow-up. Subjects were 8,905 residents of nursing homes in Niigata, Japan (mean age, 84.3 years). Fracture histories were obtained from nursing home medical records. ADL levels were assessed by caregivers. Hip fracture diagnosis was based on hospital medical records.

RESULTS

Subjects had fracture histories of upper limbs (5.0%), hip (14.0%), and nonhip lower limbs (4.6%). Among historical single fractures, only prior nonhip lower limbs significantly predicted subsequent fracture (adjusted hazard ratio, 2.43; 95% confidence interval (CI), 1.30-4.57). The stepwise method selected the best model, in which a combined historical fracture at upper limbs or nonhip lower limbs (adjusted hazard ratio, 2.14; 95% CI, 1.30-3.52), dependence, ADL levels, mobility, dementia, weight, and type of nursing home independently predicted subsequent hip fracture.

CONCLUSIONS

A fracture history at upper or nonhip lower limbs, in combination with other known risk factors, is useful for the prediction of future hip fracture in institutional settings.

Steady and transient behaviors of protoplasmic streaming in Nitella internodal cell

Steady and transient behaviors of protoplasmic streaming in Nitella internodal cell have been investigated for various temperatures from 30 degrees C to near 0 degrees C. It has been found that steady velocity of the streaming linearly decreases with increasing inverse temperature but its proportionality coefficient changes at approximately 10 degrees C. Velocity distribution, which reflects temporal fluctuations of the protoplasmic streaming, is nonGaussian and its half width becomes larger at higher temperatures. On the other hand, recovery of the protoplasmic streaming, which is observed after stopping the streaming with a current stimulus to the internodal cell, has been found to show more clear sigmoidal time courses at higher temperatures.

Fracture incidence in nursing homes in Japan

We conducted the first study to determine fracture incidence in institutionalized elderly people in East Asia. Fracture incidence was generally higher than in the general population but was not for all fracture types. Specific fracture prevention strategies for institutionalized people are needed. Ethnic differences in fracture incidence are also discussed.

INTRODUCTION

The aim of this study was to determine the incidence of fractures in nursing homes in Japan, where fracture is becoming an increasingly problematic health issue.

METHODS

We conducted a cohort study with a 1-year follow-up. Subjects were 8,905 residents (average age, 84.3 years) in nursing homes. Caregivers assessed activities of daily living levels using Barthel's index, and we collected demographic data of each resident. Fracture diagnosis was based on medical records from the hospitals where patients were admitted.

RESULTS

Incidence of hip fracture was 14.9 per 1,000 person-years for women and 9.7 for men. Incidence of forearm and upper-arm fractures was 1.9 and 5.1 for women and 0.5 and 2.1 for men, respectively. Hip and upper-arm fracture rates were higher than in the general population, but forearm fracture rates were lower. Hazard ratio of fracture incidence in totally dependent to partially dependent or independent subjects was 0.14 (95%CI 0.05-0.33) for hip fracture and 0.34 (95%CI 0.23-0.50) for all fractures.

CONCLUSIONS

Fracture incidence in institutionalized elderly people is generally higher but is not higher for all types of fractures than the general population. In addition, totally dependent persons had a much lower risk of hip fracture.

Effect of the dental adhesive, 4-META/MMA-TBB resin, on adhesion and keratinization of regenerating oral epithelium

BACKGROUND AND OBJECTIVE

The 4-META/MMA-TBB [4-(2-methacryloxyethyl)trimellitic anhydride/methyl methacrylate-tributylborane] resin is widely used as a dental adhesive. It has also been applied in the dressing of gingival wound surfaces following periodontal surgery. However, its effect on the regeneration and/or cell attachment of the oral epithelium remains to be clarified. To evaluate the effect of the resin applied as a wound dressing, we investigated expression of laminin 5, integrin beta(4) and cytokeratin 14 in regenerating oral epithelium treated with this resin following gingivectomy from the viewpoint of cell attachment and differentiation.

MATERIAL AND METHODS

The resin was applied to the entire wound surface in rats after gingival surgery, and regenerating epithelium was examined immediately and at 1, 3, 5, 7 and 14 days later. The resin was removed 2 weeks after application in some animals and tissue further examined at 1, 3, 5 and 7 days later.

RESULTS

Regenerating epithelium under the resin was not keratinized, but became keratinized immediately after removal of the resin. Laminin 5 and integrin beta(4) were immunolocalized in the basal lamina, the internal basal lamina, in marginal cells of the regenerating epithelium and at the resin-regenerating epithelium interface. Cytokeratin 14 localized in the regenerating epithelium underneath the resin, as well as in healthy and regenerated junctional epithelial cells.

CONCLUSION

These results suggest that this resin covers the wound surface and that the regenerating epithelium biologically adheres to the resin during the initial process of its regeneration.

How do bioethics teachers in Japan cope with ethical disagreement among healthcare university students in the classroom? A survey on educators in charge

OBJECTIVE

The purpose of this study was to demonstrate how educators involved in the teaching of bioethics to healthcare university students in Japan would cope with ethical disagreement in the classroom, and to identify factors influencing them.

METHODS

A cross sectional survey was conducted using self administered questionnaires mailed to a sample of university faculty in charge of bioethics curriculum for university healthcare students.

RESULTS

A total of 107 usable questionnaires were returned: a response rate of 61.5%. When facing ethical disagreement in the classroom, coping behaviour differed depending on the topic of discussion, was influenced by educators' individual clear ethical attitudes regarding the topic of discussion, and was independent of many respondents' individual and social backgrounds. Among educators, it was commonly recognised that the purpose of bioethics education was to raise the level of awareness of ethical problems, to provide information about and knowledge of those issues, to raise students' sensitivity to ethical problems, and to teach students methods of reasoning and logical argument. Yet, despite this, several respondents considered the purpose of bioethics education to be to influence students about normative ethical judgments. There was no clear relationship, however, between ways of coping with ethical disagreement and educators' sense of the purpose of bioethics education.

CONCLUSIONS

This descriptive study suggests that educators involved in bioethics education for healthcare university students in Japan coped in various ways with ethical disagreement. Further research concerning ethical disagreement in educational settings is needed to provide better bioethics education for healthcare students.

Correlations between bone mineral density and demographic, lifestyle, and biochemical variables in community-dwelling Japanese women 69 years of age and over

INTRODUCTION

A few epidemiologic studies have comprehensively attempted to identify risk factors for low bone mineral density (BMD) in elderly Asian women. The purpose of this study was to identify demographic, lifestyle, and biochemical factors correlated with BMD in elderly Japanese women 69 years of age and over.

METHODS

The study design was cross-sectional. The subjects were 583 ambulatory women aged 69 years and over, and their average age was 74.3 (SD 4.4) years. Predictor variables were age, reproductive history, anthropometric indices, grip strength, calcium intake, lifestyle information, and serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D (1,25(OH)(2)D), osteocalcin (OC), and undercarboxylated osteocalcin (ucOC) values. The outcome variable was forearm BMD measured with a DTX-200 osteometer.

RESULTS

Simple linear regression analyses showed that BMD was significantly positively associated with body height, weight, body mass index, grip strength, serum albumin concentration, and "housework," and negatively associated with age, years since menopause, age at menarche, number of children, serum 1,25(OH)(2)D concentration, serum OC concentration, and ucOC concentration. The stepwise multiple regression analysis showed that weight (beta=0.00316, SE=0.00028, R(2)=0.180), age (beta=-0.00321, SE=0.00050, R(2)=0.108), log-transformed serum OC (beta=-0.0445, SE=0.0064, R(2)=0.053), log-transformed serum 1,25(OH)(2)D (beta=-0.0401, SE=0.0074, R(2)=0.050), "farmwork" (beta=0.00904, SE=0.00426, R(2)=0.005), and serum 25(OH)D concentration (beta=0.000281, SE=0.000120, R(2)=0.003) were significantly associated with BMD.

CONCLUSION

It was concluded that body weight is a major predictor of forearm BMD among the factors measured in this study in independent Japanese women 69 years of age and over and that serum 1,25(OH)(2)D concentration may be associated with cortical BMD. Maintenance of body weight is very important for maintaining BMD in this population, unless a large weight aggravates obesity-related diseases. A follow-up study is needed to confirm these findings.

Response to preoperative chemotherapy affects prognosis in esophageal cancer

The effect of preoperative chemotherapy on prognosis is still controversial. We have investigated the relationship between responses to preoperative chemotherapy and prognosis after curative operations in patients with esophageal squamous cell carcinoma. Thirty-nine patients received preoperative chemotherapy with continuous infusion of 500 mg/m2 of 5-fluorouracil (5-FU) and intravenous injection of 20 mg/m2 of leucovorin every 12 hours for 5 days. On the 5th day alone, 70 mg/m2 of cisplatin was also infused. The effect was evaluated approximately 14 days after the end of one course of chemotherapy. The rates of responders and non-responders were 64.1% and 35.9%, respectively. After an interval of 21-28 days, transthoracic esophagectomy was performed. Significant histological effect by chemotherapy was found in responders compared to non-responders (P < 0.05). Responders had a significantly better prognosis than non-responders by Log-rank test (P < 0.01). This suggests that preoperative chemotherapy may contribute to better prognosis when the tumor is sensitive to chemotherapy.

Finite element analysis of the stresses around fixtures in various reconstructed mandibular models--part II (effect of horizontal load)

AIM OF EXPERIMENT: Having already studied the effect of vertical load (Nagasao et al., 2002), the purpose of this study was to investigate the effect of horizontal load on implants embedded into a virtually reconstructed mandible.

MATERIAL AND METHODS

Three-dimensional virtual models of various reconstructed mandibles were designed on a PC and 50 N horizontal loads were applied on the cantilever portion of the upper structure. Then, using a finite element analysis, stresses occurring around the implants were calculated, and the directions of the forces that cause the maximum von Mises stresses were evaluated. Finally, the results were compared with those from vertical loading.

RESULTS

In all models, the maximum stresses occurred around the implants embedded on the premolar region of the loaded side. In addition, the locations at which the maximum von Mises stresses occurred were greatly influenced by the structural character of the loaded side.

CONCLUSION

When horizontal loads were applied to reconstructed mandibles, the location and direction of the maximum stresses around the dental implants appeared to be influenced much more by the structural characters of the reconstructed mandibles when compared with vertical loads.