Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links

BACKGROUND

Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures.

AIMS AND METHODS

To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured.

RESULTS

CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death.

CONCLUSION

SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.

A prospective study of human papillomavirus (HPV) testing to resolve uncertainty in colposcopy

OBJECTIVE

UK colposcopy services are seeing increased workloads, a large proportion of which are follow-up appointments. The English Cervical Screening Programme HPV Special Interest Group identified five subcategories of colposcopy clinic patients who often require prolonged follow-up regimes for low-grade abnormalities. Human papillomavirus (HPV) testing has a high negative predictive value, meaning that HPV-negative women are at very low risk of underlying disease. Our objectives were to quantify the number of HPV-negative women in each study subcategory and to evaluate the number who could potentially be discharged from colposcopy on the basis of their results.

METHODS

Four colposcopy clinics prospectively identified women according to five categories over 12 months. All women underwent cytological testing and high-risk HPV (hrHPV) testing using the Hybrid Capture 2 test. Management outcomes and decisions based on a knowledge of the HPV status were recorded.

RESULTS

Data available on 755 women showed that 422/755 (55.9%) and 260/755 (34.4%) had persistent cervical intraepithelial neoplasia grade 1 (CIN1) (Category 1) or a minor abnormality following treatment (Category 2), respectively. In Categories 1 and 2, 51.7% and 60.2%, respectively, were hrHPV negative. The rates with biopsies of CIN2 or worse (CIN2+) across the two categories were 3/355 (0.8%) and 21/291 (7.0%) for hrHPV-negative and hrHPV-positive women, respectively.

CONCLUSION

The incorporation of hrHPV testing within organized cervical screening programmes has been widely accepted. hrHPV testing for the clinical scenarios outlined in this study detects women who are hrHPV negative and therefore at low risk of underlying disease, potentially reducing anxiety and inconvenience for women and costs to colposcopy services.

Tumour-free distance from serosa is a better prognostic indicator than depth of invasion and percentage myometrial invasion in endometrioid endometrial cancer

OBJECTIVE

To evaluate the prognostic performance of tumour-free distance (TFD) compared with depth of invasion (DOI) and percentage of myometrial invasion (MI).

DESIGN

Retrospective cohort study.

SETTING

Regional gynaecological oncology centre.

POPULATION

All women identified with stage I-III endometrioid endometrial carcinoma from January 2000 to December 2007, who had surgery at the Northern Gynaecological Oncology Centre (NGOC).

METHODS

Surgicopathological, follow-up and survival data were collected. Univariate and multivariate analyses were performed comparing TFD, DOI and MI with known prognostic factors. The prognostic accuracy of TFD was assessed by receiver operating characteristic (ROC) curve analyses, and an optimum cut-off was proposed.

MAIN OUTCOME MEASURES

Death from disease, recurrence and pelvic lymph node involvement.

RESULTS

A total of 288 women were identified. The median follow-up time was 67 months, with 40 recurrences and 32 disease-related deaths. When TFD, DOI and MI were separately examined in multivariate analyses with other covariates, TFD was an independent predictor of death from disease (HR 1.22; 95% CI 1.00-1.48; P = 0.05). In multivariate analyses including all three measures together (TFD, DOI and MI), TFD was an independent predictor of death from disease (HR 1.49; 95% CI 1.03-2.16; P = 0.04) and recurrence (HR 1.39; 95% CI 1.01-1.91; P = 0.05). TFD was also an independent predictor of lymph node involvement when examined separately (OR 0.74; 95% CI 0.56-0.96; P = 0.03), and together with DOI and MI (OR 0.67; 95% CI 0.49-0.92; P = 0.01), in women who had pelvic lymphadenectomy (n = 86). A TFD cut-off of 1.75 mm showed good prognostic performance.

CONCLUSIONS

The TFD measure may be a more accurate method of representing myometrial invasion in the staging for endometrial cancer.

Observation of magnetically induced transparency in a classical magnetized plasma

We report the first demonstration of magnetically induced transmission in an opaque magnetized plasma. Magnetically induced transmission in a plasma is a classical analog to the electromagnetically induced transparency in atomic systems. The transmission of radiation through an axially magnetized plasma is obtained by applying an additional one dimensional transverse spatial periodic magnetic field. The transverse-periodic magnetic field uncouples the right-hand electromagnetic wave from interacting with plasma electrons, rendering the plasma band-stop transparent. This provides means to control the extent of absorption of electromagnetic radiation in magnetized plasma.

Monitoring indicates greater resilience for birds than for mammals in Kakadu National Park, northern Australia

Context A previous study reported major declines for native mammal species from Kakadu National Park, over the period 2001–09. The extent to which this result may be symptomatic of more pervasive biodiversity decline was unknown. Aims Our primary aim was to describe trends in the abundance of birds in Kakadu over the period 2001–09. We assessed whether any change in bird abundance was related to the arrival of invading cane toads (Rhinella marina), and to fire regimes. Methods Birds were monitored at 136 1-ha plots in Kakadu, during the period 2001–04 and again in 2007–09. This program complemented sampling of the same plots over the same period for native mammals. Key results In contrast to the decline reported for native mammals, the richness and total abundance of birds increased over this period, and far more individual bird species increased than decreased. Fire history in the between-sampling period had little influence on trends for individual species. Interpretation of the overall positive trends for bird species in Kakadu over this period should be tempered by recognition that most of the threatened bird species present in Kakadu were unrecorded in this monitoring program, and the two threatened species for which there were sufficient records to assess trends – partridge pigeon (Geophaps smithii) and white-throated grass-wren (Amytornis woodwardi) – both declined significantly. Conclusions The current decline of the mammal fauna in this region is not reflected in trends for the region’s bird fauna. Some of the observed changes (mostly increases) in the abundance of bird species may be due to the arrival of cane toads, and some may be due to local or regional-scale climatic variation or variation in the amount of flowering. The present study provides no assurance about threatened bird species, given that most were inadequately recorded in the study (perhaps because their decline pre-dated the present study). Implications These contrasting trends between mammals and birds demonstrate the need for biodiversity monitoring programs to be broadly based. The declines of two threatened bird species over this period indicate the need for more management focus for these species.

Ion temperature and hydrodynamic-energy measurements in a Z-pinch plasma at stagnation

The time history of the local ion kinetic energy in a stagnating plasma was determined from Doppler-dominated line shapes. Using independent determination of the plasma properties for the same plasma region, the data allowed for inferring the time-dependent ion temperature, and for discriminating the temperature from the total ion kinetic energy. It is found that throughout most of the stagnation period the ion thermal energy constitutes a small fraction of the total ion kinetic energy; the latter is dominated by hydrodynamic motion. Both the ion hydrodynamic and thermal energies are observed to decrease to the electron thermal energy by the end of the stagnation period. It is confirmed that the total ion kinetic energy available at the stagnating plasma and the total radiation emitted are in balance, as obtained in our previous experiment. The dissipation time of the hydrodynamic energy thus appears to determine the duration (and power) of the K emission.

The mammal fauna of the Sir Edward Pellew island group, Northern Territory, Australia: refuge and death-trap

Context Australian islands have provided a major conservation refuge for many native mammals; however, conversely, island populations may also be highly susceptible to the introduction of novel threats. Nearby islands subject to different arrays of threats or different timing of arrival of those threats may provide a natural experiment, offering particular insight into the relative impacts of different threats to Australian mammals more generally. Aims The present study sought to document the native mammal fauna occurring on the main islands of the Sir Edward Pellew group, Northern Territory, and the changes in that fauna over a ~50-year period, and to seek to identify those factors that have contributed to such change. Methods In different combinations, the five main islands (and three smaller islands) were subject to standard wildlife survey methods in 1966–67, 1988, 2003, 2004–05, and 2009–10. Sampling procedures were not identical in all periods; however, a measure of abundance (trap success rate) could be calculated for all sampling. This conventional survey approach was complemented by documentation of ethno-biological knowledge. Key results For many species, these islands held populations of biogeographic or conservation significance. However, there has been a major loss or decline of mammal species from most islands. Extirpation is difficult to prove; however, we consider it most likely that the important regional populations of brush-tailed rabbit-rat (Conilurus penicillatus), northern quoll (Dasyurus hallucatus), northern brush-tailed phascogale (Phascogale pirata), common brushtail possum (Trichosurus vulpecula) and canefield rat (Rattus sordidus) have been lost from these islands, and that northern brown bandicoot (Isoodon macrourus), western chestnut mouse (Pseudomys nanus), pale field-rat (Rattus tunneyi) and long-haired rat (Rattus villosissimus) have been lost from most of the islands on which they formerly occurred. Some species–island combinations are known only from the ethno-biological record, and the loss of these populations probably mostly occurred in the period 30–50 years ago. Many other declines and losses occurred in the period between the second (1988) and third (2003) survey. The loss of the northern quoll from Vanderlin Island occurred in 2008. No single factor unambiguously accounts for the declines, although the introduction of cats (Felis catus) provides the best fit to the pattern of decline. A notable exception is the extirpation of northern quoll on Vanderlin Island, which is closely linked to the colonisation of that island by cane toads (Rhinella marina). Conclusions The Sir Edward Pellew group of islands have lost much of their formerly high conservation significance for native mammals over the past 50 years, mostly because of introductions of cats, and to a lesser extent, natural colonisation of the islands by cane toads. Implications The present study has provided some insight into the relative impacts of a range of factors that have been considered as possibly implicated in the decline of native mammals on the northern Australian mainland, with most support being offered here for a primary role for predation by feral cats. The study has also demonstrated the need for better quarantining of islands with significant conservation values. The comprehensive natural colonisation of these islands by cane toads offers a further lesson, of most importance to managers of islands in north-western Australia currently just beyond the range of toads.

Bisphosphonate use and hip fracture epidemiology: ecologic proof from the contrary

AIM

The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005-2008 in the Australian Capital Territory (ACT).

METHODS

Annual sex- and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases.

RESULTS

In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007-2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007-2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999-2008.

CONCLUSION

Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.

Monitoring indicates rapid and severe decline of native small mammals in Kakadu National Park, northern Australia

Context. Australia has a lamentable history of mammal extinctions. Until recently, the mammal fauna of northern Australia was presumed to have been spared such loss, and to be relatively intact and stable. However, several recent studies have suggested that this mammal fauna may be undergoing some decline, so a targeted monitoring program was established in northern Australia’s largest and best-resourced conservation reserve. Aims. The present study aims to detect change in the native small-mammal fauna of Kakadu National Park, in the monsoonal tropics of northern Australia, over the period of 1996–2009, through an extensive monitoring program, and to consider factors that may have contributed to any observed change. Methods. The small-mammal fauna was sampled in a consistent manner across a set of plots established to represent the environmental variation and fire regimes of Kakadu. Fifteen plots were sampled three times, 121 plots sampled twice and 39 plots once. Resampling was typically at 5-yearly intervals. Analysis used regression (of abundance against date), and Wilcoxon matched-pairs tests to assess change. For resampled plots, change in abundance of mammals was related to fire frequency in the between-sampling period. Key results. A total of 25 small mammal species was recorded. Plot-level species richness and total abundance decreased significantly, by 54% and 71%, respectively, over the course of the study. The abundance of 10 species declined significantly, whereas no species increased in abundance significantly. The number of ‘empty’ plots increased from 13% in 1996 to 55% in 2009. For 136 plots sampled in 2001–04 and again in 2007–09, species richness declined by 65% and the total number of individuals declined by 75%. Across plots, the extent of decline increased with increasing frequency of fire. The most marked declines were for northern quoll, Dasyurus hallucatus, fawn antechinus, Antechinus bellus, northern brown bandicoot, Isoodon macrourus, common brushtail possum, Trichosurus vulpecula, and pale field-rat, Rattus tunneyi. Conclusions. The native mammal fauna of Kakadu National Park is in rapid and severe decline. The cause(s) of this decline are not entirely clear, and may vary among species. The most plausible causes are too frequent fire, predation by feral cats and invasion by cane toads (affecting particularly one native mammal species). Implications. The present study has demonstrated a major decline in a key conservation reserve, suggesting that the mammal fauna of northern Australia may now be undergoing a decline comparable to the losses previously occurring elsewhere in Australia. These results suggest that there is a major and urgent conservation imperative to more precisely identify, and more effectively manage, the threats to this mammal fauna.

Factors Associated with Aromatase Inhibitor Use in a Large Cohort of Women Cared for in an Integrated Health Plan

Background: Third generation aromatase inhibitors (AI) have been well tolerated in clinical trials and may have fewer side effects than tamoxifen. While national treatment guidelines recommend AI for postmenopausal women with ER+ tumors, the extent to which women are prescribed AIs in community settings in the U.S., and as front-line or extended therapy, remains unknown. Using data from a large non-profit health plan that serves over 3 million residents in Southern California, we report results examining the characteristics of breast cancer (BCa) survivors who were ever prescribed AIs.Methods: This cross-sectional analysis examined a cohort of 25,577 BCa (in situ and invasive cases) diagnosed from 1996-2006. We collected demographic, tumor, and cancer treatment information from automated health plan databases and SEER-affiliated cancer registry files. We identified patient and clinical factors associated with AI use. P-values (2-sided) were based on the chi-square distribution. Adjusted odds ratios (for age and year at diagnosis) and 95% confidence intervals were estimated using logistic regression.Results: In this cohort, nearly 37% ever used AIs (P&lt;0.0001). Use of AIs increased by year (P&lt;0.0001). Compared to non-Hispanic whites, minority women were less likely prescribed AIs (AOR=0.75 for blacks, 95% CI: 0.69-0.81). Although most women who used AI were first diagnosed with early stage disease (2 cm vs. &lt;1cm). Women with positive lymph nodes had twice the odds of AI use (OR=2.27, 95% CI: 2.13-2.42) than those with negative nodes. Women with ER+ or PR+ lesions were more likely to have ever used AI (P&lt;0.0001) as were those with HER- tumors (AOR=1.67, 95% CI: 1.48-1.89). Women who underwent breast conserving surgery without radiation were 36% less likely to use AI (AOR=0.64 95% CI: 0.59-0.69) than those with radiation. Of the total cohort, nearly 64% received adjuvant treatment. Among the 6716 women who received tamoxifen, about 43% (2918/6716) also used AI. Of note, during the 2005-2006 diagnosis years, the percentage treated with tamoxifen dropped among women ever prescribed AI. Of the 6627 women treated with chemotherapy only, 36% also received AI (2354/6627).Conclusions: Odds of AI use were greater among older women (age 60+), white race, higher stage at diagnosis, worse histology, positive lymph nodes, and those with ER+, PR+, or HER- tumors. However, grade and tumor size did not influence AI use. More work is needed to determine how patterns of AI use alone or following tamoxifen, medication changes, and tumor characteristics at initial diagnosis impact long-term breast cancer recurrence in this diverse group of patients in southern California.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2079.

Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy

To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.

Sexual dysfunction in subjects with Klinefelter's syndrome

While the association of Klinefelter's Syndrome (KS) with infertility is well-known, very few investigations have evaluated the prevalence of sexual dysfunction in KS. The aim of the present study was to systematically analyse the prevalence of KS in a consecutive series of adult male patients consulting for sexual problems and to investigate its specific correlates. Among a consecutive series of 1386 men (mean age 48.9 +/- 12.7 years old), 23 (1.7%) subjects with KS were found. Patients with KS were younger and more often hypogonadal when compared with the rest of the sample. Among patients with KS, five (22.7%) subjects reported severe erectile dysfunction, 14 (60.9%) hypoactive sexual desire (HSD), two (9.5%) premature and two (9.5%) delayed ejaculation. Only the association between KS and HSD was confirmed after adjustment for age [HR = 3.2 (1.37-7.5)], however, when patients with KS were compared with age, smoking habit, and testosterone matched controls, even the association between KS with HSD disappeared. In comparison to matched hypogonadal controls, subjects with KS had lower levels of education, a higher frequency of cryptorchidism and poorer pubertal progression. In conclusion, our results indicate that sexual dysfunction present in KS is not specifically associated with the syndrome but is caused by the underlying hypogonadal state. Further studies are needed to evaluate the efficacy of testosterone substitution in ameliorating the hypoactive sexual desire often reported in subjects with KS.

Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study

OBJECTIVE

The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy').

RESEARCH DESIGN AND METHODS

Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV.

RESULTS

A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (+/-SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 +/- 0.17 vs. 5.4 +/- 0.22 days, p < 0.01; and LOIV, 3.6 +/- 0.17 vs. 4.8 +/- 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 +/- 0.30 vs. 5.9 +/- 0.37 days, p = 0.07; and LOIV, 3.7 +/- 0.33 vs. 5.2 +/- 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources.

CONCLUSIONS

Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

Bronchial epithelial cells cultured from clinically stable lung allograft patients promote the development of macrophages from monocytes rather than dendritic cells

BACKGROUND

It is understood that chronic allograft failure occurs as a result of alloimmune and non-alloimmune injury. Dendritic cells (DC) are thought to be crucial in regulating (allo)immune airway damage and interactions with epithelial cells are likely. Studies in human lung transplantation are limited, however, and the available literature on DC is inconsistent. This study focused on the ex vivo influence of primary bronchial epithelial cells derived from lung allografts on DC differentiation.

METHODS

Epithelial cell conditioned media (ECCM) were added to monocytes differentiating into DC under the influence of interleukin-4 and granulocyte macrophage-colony stimulating factor. The resultant cells were compared with DC cultured without ECCM and with monocyte-derived macrophages. Expression of typical DC (eg, CD1a) and macrophage (eg, CD14) markers was assessed by flow cytometry. Phenotypical assessments were complemented by functional studies of mannose receptor-mediated phagocytosis (FITC-dextran uptake) and antigen-presenting capability (mixed lymphocyte reactions).

RESULTS

Cells exposed to ECCM expressed significantly lower levels of CD1a than unexposed DC. CD14 expression and phagocytic function were increased. ECCM cultured cells also expressed lower levels of T cell co-stimulatory molecules, secreted an anti-inflammatory cytokine profile and had significantly reduced antigen-presenting capability.

CONCLUSION

Using phenotypic and functional approaches, this study has shown that ECCM from lung allografts drives the production of macrophage-like cells from monocytes rather than DC. The data suggest that epithelial cells may restrain airway DC and potential alloimmunity. It is unclear whether the observed effect is specifically seen in lung transplant recipients or is a general property of bronchial epithelial cells. This may reflect a homeostatic inter-relationship between airway epithelial and DC populations relevant both to lung allografts and the lung more generally.

Measurement of the e;{+}e;{-}-->bb[over ] Cross Section between sqrt[s]=10.54 and 11.20 GeV

We report e;{+}e;{-}-->bb[over ] cross section measurements by the BABAR experiment performed during an energy scan in the range of 10.54 to 11.20 GeV at the SLAC PEP-II e;{+}e;{-} collider. A total relative error of about 5% is reached in more than 300 center-of-mass energy steps, separated by about 5 MeV. These measurements can be used to derive precise information on the parameters of the Upsilon(10860) and Upsilon(11020) resonances. In particular we show that their widths may be smaller than previously measured.

The Australian Collaborative Rangelands Information System: preparing for a climate of change

Change is a constant in Australia’s rangelands. Appropriate management of this change requires a sound knowledge of drivers (e.g. climate variability, livestock grazing), their impacts on natural resources (state and trend), socio-economic outcomes, and how these feed back through learning and adaptive management to affect drivers and their impacts. Information is required at scales from enterprise to national, with regional and broader level information serving to influence rangelands governance through institutional arrangements, policy and funding programs. The Australian Collaborative Rangelands Information System (ACRIS) collates and analyses data from national sources and from its State and Territory jurisdictional partners to track and understand change at regional to national scales. ACRIS has recently reported changes between 1992 and 2005 in several biophysical and socio-economic themes at bioregional resolution. This paper describes the processes used to collate and analyse the often disparate data, to synthesise information across data types and to integrate emergent higher order information across drivers, impacts and outcomes to provide more complete understanding of change. Data gaps and inconsistencies were a major challenge, and we illustrate how some of these issues were addressed by using indicators to report changes in biodiversity. ACRIS now needs to foster increased coordinated monitoring activity and develop its reporting capacity to become the valued information system for Australia’s rangelands. We propose that future improvements will be best structured within a hierarchically nested framework that provides consistent overarching data at national scale relevant to the variety of rangeland values (e.g. change in ground cover) but focuses on regionally-relevant ecosystem services, and their appropriate measures, at the regional scale. A key challenge is to implement consistent and systematic methods for monitoring biodiversity within this hierarchical framework, given limited institutional resources. Finally, ACRIS needs to develop a dynamic web-based delivery system to enable more frequent and flexible reporting of interpreted change than is possible through periodic published reports.

Feasibility of a nitrogen-recombination soft-x-ray laser using capillary discharge Z pinch

Capillary discharge Z pinches have been shown to be efficient drivers for x-ray lasers (XRLs). In this work we examine the possibility of realizing a H_{alpha} nitrogen recombination laser ( 3-->2 transition) at lambda=13.4nm , using a capillary discharge Z pinch. A pulsed power generator with 60kA peak current and 70ns quarter period have been used to generate Z -pinch plasma in a 90-mm -long and 5-mm -diameter capillary. The plasma conditions were evaluated experimentally, using a filtered x-ray diode detector and time-integrated spectroscopy. The conditions required for the XRL were analytically estimated based on simple steady-state rate equations and then compared to experimental results. We demonstrated above 10% N7+ abundance at pinch time, while at least 50% is required. Then, in the expansion phase, the plasma is cooled in a time less than 5ns to temperatures below 60eV , as needed for the recombination laser. These results suggest that the required conditions for nitrogen-recombination lasing could be achieved in a capillary discharge Z pinch, but a higher-power driver might be needed.

Observation of the bottomonium ground state in the decay Upsilon(3S)-->gammaetab

We report the results of a search for the bottomonium ground state etab(1S) in the photon energy spectrum with a sample of (109+/-1) million of Upsilon(3S) recorded at the Upsilon(3S) energy with the BABAR detector at the PEP-II B factory at SLAC. We observe a peak in the photon energy spectrum at Egamma=921.2(-2.8)+2.1(stat)+/-2.4(syst) MeV with a significance of 10 standard deviations. We interpret the observed peak as being due to monochromatic photons from the radiative transition Upsilon(3S)-->gammaetab(1S). This photon energy corresponds to an etab(1S) mass of 9388.9(-2.3)+3.1(stat)+/-2.7(syst) MeV/c2. The hyperfine Upsilon(1S)-etab(1S) mass splitting is 71.4(-3.1)+2.3(stat)+/-2.7(syst) MeV/c2. The branching fraction for this radiative Upsilon(3S) decay is estimated to be [4.8+/-0.5(stat)+/-1.2(syst)]x10(-4).

The ischemic preconditioning paradox in deceased donor liver transplantation-evidence from a prospective randomized single blind clinical trial

While animal studies show that ischemic preconditioning (IPC) is beneficial in liver transplantation (LT), evidence from few smaller clinical trials is conflicting. From October 2003 to July 2006, 101 deceased donors (DD) were randomized to 10 min IPC (n = 50) or No IPC (n = 51). Primary objective was efficacy of IPC to decrease reperfusion (RP) injury. Both groups had similar donor risk index (DRI) (1.54 vs. 1.57). Aminotransferases on days 1 and 2 were significantly greater (p < 0.05) in IPC recipients. In multivariate analyses, IPC had an independent effect only on day 2 aspartate transferase. Prothrombin time, bilirubin and histological injury were similar in both groups. IPC had no significant effect on plasma TNF-alpha, IL-6 and IL-10 in the donor and TNF-alpha and IL-6 in the recipient. In contrast, IPC recipients had a significant rise in systemic IL-10 levels after RP (p < 0.05) and had fewer moderate/severe rejections within 30 days (p = 0.09). Hospital stay was similar in both groups. One-year patient and graft survival in IPC versus No IPC were 88% versus 78% (p = 0.1) and 86 versus 76% (p = 0.25), respectively. IPC increases RP injury after DDLT, an 'IPC paradox'. Other potential benefits of IPC are limited. IPC may be more effective in combination with other preconditioning regimens.

In vitro metabolism of indiplon and an assessment of its drug interaction potential

This study was designed to study the in vitro metabolism of indiplon, a novel hypnotic agent, and to assess its potential to cause drug interactions. In incubations with pooled human liver microsomes, indiplon was converted to two major, pharmacologically inactive metabolites, N-desmethyl-indiplon and N-desacetyl-indiplon. The N-deacetylation reaction did not require NADPH, and appeared to be catalyzed by organophosphate-sensitive microsomal carboxylesterases. The N-demethylation of indiplon was catalyzed by CYP3A4/5 based on the following observations: (1) the sample-to-sample variation in N-demethylation of indiplon ([S] = 100 microM) in a bank of human liver microsomes was strongly correlated with testosterone 6beta-hydroxylase (CYP3A4/5) activity (r(2) = 0.98), but not with any other CYP enzyme; (2) recombinant CYP1A1, CYP1A2, CYP3A4, CYP3A5 and CYP3A7 had the ability to catalyze this reaction; (3) the N-demethylation of indiplon was inhibited by CYP3A4/5 inhibitors (ketoconazole and troleandomycin), but not by a CYP1A2 inhibitor (furafylline). In pooled human liver microsomes, indiplon exhibited a weak capacity to inhibit CYP1A2, CYP2A6, CYP2C8, CYP2C9, CYP2D6, CYP2E1, CYP3A4/5 and carboxylesterase (p-nitrophenylacetate hydrolysis) activities (IC50 >/= 20 microM). Clinical data available on indiplon support the conclusions of this paper that the in vitro metabolism of indiplon is catalyzed by multiple enzymes, and indiplon is a weak inhibitor of human CYP enzymes.

Ion-kinetic-energy measurements and energy balance in a Z-pinch plasma at stagnation

The ion-kinetic energy throughout K emission in a stagnating plasma was determined from the Doppler contribution to the shapes of optically thin lines. X-ray spectroscopy with a remarkably high spectral resolution, together with simultaneous imaging along the pinch, was employed. Over the emission period, a drop of the ion-kinetic energy down to the electron thermal energy was seen. Axially resolved time-dependent electron-density measurements and absolute intensities of line and continuum allowed for investigating, for the first time, each segment of the pinch, the balance between the ion-kinetic energy at the stagnating plasma, and the total radiation emitted. Within the experimental uncertainties, the ion-kinetic energy is shown to account for the total radiation.

Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention

BACKGROUND

No specific preventive strategy exists for acute gastrointestinal haemorrhage in hip fracture patients.

AIMS

To determine the effectiveness of prophylactic use of proton pump inhibitors in patients with risk factors for acute gastrointestinal haemorrhage.

METHODS

Prospective two-stage study of 822 consecutive older (> or =60 years) hip fracture patients.

RESULTS

Acute gastrointestinal haemorrhage occurred in 16 (3.9%) of 407 patients and was associated with increased length of hospital stay (28.7 vs. 15.9; P = 0.0027) and mortality (18.8% vs. 4.3%; P = 0.043). Multiple analysis identified five independent risk factors for acute gastrointestinal haemorrhage: pre-existing peptic ulcer (OR 4.3; P = 0.043), current smoking (OR 3.1; P = 0.023), post-operative use of an antiplatelet agent (OR 6.5; P = 0.046), post-operative use of non-steroidal anti-inflammatory drug/cyclo-oxygenase-2 inhibitor (OR 4.9; P = 0.06) and blood group O (OR 1.7; P = 0.046). These risk factors were highly sensitive and had a negative predictive value of 99.8%. Prophylactic use of proton pump inhibitors in patients with risk factor for acute gastrointestinal haemorrhage significantly reduced the incidence of this complication (0.72% in treated patients vs. 13.4% in untreated; P < 0.001); the number needed to treat was 7.9. Conclusions In older hip fracture patients perioperative acute gastrointestinal haemorrhage occurs in 3.9% and is associated with poor outcome. Preventive proton pump inhibitor therapy in patients at risk of acute gastrointestinal haemorrhage is effective and safe.

Factors affecting the management of cattle grazing distribution in northern Australia: preliminary observations on the effect of paddock size and water points

Achieving more uniform grazing at landscape and paddock scales is seen as an important management objective by pastoralists in northern Australia, but it is difficult to attain in practice. This paper presents a brief review of some key factors to be considered in attempts to modify grazing distribution in extensive rangelands by drawing on the preliminary results of a project that is investigating several options for achieving more uniform grazing. Subdividing the landscape into smaller paddocks and, to a lesser extent, installing additional water points in large paddocks are effective in distributing grazing more widely across the landscape. However, these approaches are less effective in achieving uniform grazing within paddocks, and areas of concentrated use still occur even in small paddocks. To achieve spatial grazing objectives, it is necessary to use management tools that operate at the appropriate scale. Attaining more even use within paddocks should therefore be viewed as a separate management objective, requiring different techniques, to obtaining more effective use of the landscape as a whole. Integrating the use of several spatial management tools that act at different scales is likely to be most effective in improving grazing distribution. Our findings also highlight the importance of understanding paddocks in terms of the spatial arrangement of forage resources and their acceptability and quality in relation to water points and other landscape features. Differences between individual cattle in the way they use the landscape are important in producing more uniform use in larger paddocks and may also offer other opportunities for improving the use of landscape resources overall. Finally, the implications of more uniform use for livestock production and other land use values should be considered, with the protection of biodiversity values potentially requiring special management arrangements where more even use is achieved.