Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery

BACKGROUND

Robot-assisted coronary artery bypass grafting requires continuous one-lung ventilation (OLV) to evacuate the thoracic cavity. Whether this ventilatory mode subjects patients to serious hypoxemia remains underinvestigated.

METHODS

From 2005 to 2010, all patients receiving robot-assisted coronary artery bypass graft surgery using OLV with active capnothorax for internal mammary artery harvesting and then passive pneumothorax for minithoracotomy direct-vision coronary bypass graft surgery were included. Patients' variables of oxygenation were monitored and compared throughout the whole surgical period. Persistent oxygen desaturation (arterial oxygen pressure <70 mm Hg) refractory to primary managements was defined as a hypoxemic event, and predictors of such events were identified by multivariate regression analysis.

RESULTS

A total of 255 consecutive patients were enrolled. Average oxygen saturation decreased modestly during the first stage of OLV with active capnothorax, causing hypoxemic events in 9 patients (4.3%) leading to death in 2 (0.8%), whereas it dropped drastically in the second stage of OLV with passive pneumothorax, resulting in hypoxemic events in 32 patients (12.6%) and death in 1 (0.4%). Multivariate regression analysis identified high pulmonary vascular resistance and low left ventricular ejection fraction as predictors of hypoxemia during internal mammary artery takedown, whereas prolonged procedure and chronic obstructive pulmonary disease were identified as predictors during minithoracotomy bypass grafting.

CONCLUSIONS

Robot-assisted two-stage coronary artery bypass surgery employing OLV could be complicated by serious hypoxemia especially at the minithoracotomy grafting stage and in patients with specific risk factors. Thus, when managing such patients, invasive monitoring and aggressive treatment of arterial desaturation are mandatory to ensure the patient's safety and procedural smoothness.

Etanercept restores the antinociceptive effect of morphine and suppresses spinal neuroinflammation in morphine-tolerant rats

BACKGROUND

In the present study we examined the effect of the tumor necrosis factor (TNF)-α antagonist etanercept on the antinociceptive effect of morphine in morphine-tolerant rats.

METHODS

Male Wistar rats were implanted with 2 intrathecal catheters, and 1 was connected to a mini-osmotic pump for either morphine (15 μg/h) or saline (1 μL/h) infusion for 5 days. On day 5, either etanercept (5 μg, 25 μg, and 50 μg/10 μL) or saline (10 μL) was injected via the other catheter after morphine infusion was discontinued. Three hours later, morphine (15 μg/10 μL, intrathecally) was given and tail-flick latency was measured to evaluate the antinociceptive effect of morphine. Rats were then killed and their spinal cords were removed for quantitative real-time polymerase chain reaction and immunohistochemistry to measure proinflammatory cytokines expression.

RESULTS

We found that acute etanercept (50 μg) treatment preserved a significant antinociceptive effect of morphine in morphine-tolerant rats. In addition, the expression of TNFα mRNA was increased by 2.5-fold, interleukin (IL)-1β mRNA increased by 13-fold and IL-6 mRNA by 111-fold in the dorsal spinal cord of morphine-tolerant rats. The increase in TNFα, IL-1β, and IL-6 mRNA expression was blocked by 50 μg etanercept pretreatment. The immunohistochemistry analysis revealed that 50 μg etanercept suppressed proinflammatory cytokines expression and neuroinflammation in the microglia.

CONCLUSIONS

The present study demonstrates that etanercept restores the antinociceptive effect of morphine in morphine-tolerant rats by inhibition of proinflammatory cytokine TNF-α, IL-1β, and IL-6 expression and spinal neuroinflammation. The results suggest that etanercept could also be an adjuvant therapy for morphine tolerance, which extends the effectiveness of opioids in clinical pain management.

Characterization of receptors for osteogenic protein-1/bone morphogenetic protein-7 (OP-1/BMP-7) in rat kidneys

BACKGROUND

Osteogenic protein-1/bone morphogenetic protein-7 (OP-1/BMP-7), a member of the transforming growth factor-beta superfamily, has been shown to prevent kidney damage from ischemia/reperfusion injury in rats. The molecular events involved in OP-1 action on kidney are not yet understood.

METHODS

In this study, we evaluated the biodistribution of (125)I-labeled OP-1 in rat kidneys. Adult rats received a single intravenous injection of 250 microg (125)I-labeled OP-1 per kg body wt, a dose that was effective in protecting kidneys from ischemic injury. Tissue localization, in situ hybridization, and immunostaining with a specific receptor antibody were performed to identify OP-1 cellular targets. Also, isolated plasma membranes from kidney cortex and medulla regions were analyzed to identify and characterize receptor structural components that recognize OP-1.

RESULTS

At 10 and 180 minutes following injection, the relative uptake of (125)I-labeled OP-1 was consistently higher in kidney cortex than in medulla region. Upon autoradiography, kidney tissue sections revealed that OP-1 bound to the convoluted tubule epithelium, glomeruli, and collecting ducts. Moreover, in situ hybridization and immunostaining methods have shown localization of mRNA transcripts and the protein for BMP receptor type II in the cortex and medulla in similar areas as (125)I-labeled OP-1. Bulk membranes (enriched with plasma membranes) isolated from the cortex and medulla regions of kidney each bound specifically to (125)I-OP-1, and the binding of (125)I-labeled OP-1 was inhibited by unlabeled OP-1 in a dose-dependent manner. However, platelet-derived growth factor, transforming growth factor-beta, insulin-like growth factor, fibroblast growth factors, and other members of BMP family such as BMP-2 and cartilage-derived morphogenetic protein-1/growth and differentiation factor-5 (CDMP-1/GDF-5) failed to inhibit the binding of (125)I-labeled OP-1 to receptors, suggesting a high degree of specificity with which OP-1 bound to kidney receptors. Scatchard analysis of quantitative binding data indicated that the OP-1 receptors of kidney contained a single class of high-affinity binding sites for OP-1 with an association constant (Ka) of 2.26 x 109 mol/L-1 and a binding capacity of 1.01 pmol of OP-1 per mg membrane protein. When analyzed by a ligand blot technique, plasma membranes isolated from kidney cortex and medulla each showed the presence of a prominent specific band with a relative molecular mass (Mr) of 100 kD. Further analysis by Western blotting indicated that an antibody raised against BMP type II receptor effectively recognized the 100 kD OP-1 binding component of kidney plasma membranes.

CONCLUSIONS

We demonstrated, to our knowledge for the first time, the presence of membrane-bound, specific, high-affinity OP-1 receptors in rat kidney tissues, which are likely to mediate OP-1 actions in the kidney. The major OP-1-binding component of the kidney appears to be a long form of BMP type II receptor with a Mr of 100 kD. In vivo and in vitro evidence suggests that the cellular targets for OP-1 are convoluted tubule epithelium, glomeruli, and collecting ducts. OP-1 does not share receptor binding properties with other growth factors, including BMP-2 and CDMP-1, suggesting that its mode of action in kidney appears to be specific.

Mineralized bone loss at different sites in dialysis patients: implications for prevention

To characterize the magnitude and location of mineralized bone loss, 40 patients (20 men, 20 women, 29 white, 11 black) with clinically significant renal osteodystrophy who could be unambiguously classified based on histologic criteria as having osteitis fibrosa (OF; 20 cases) or osteomalacia (OM; 20 cases) were studied; they had been on maintenance hemodialysis for 4.6 +/- 3.0 yr. One hundred forty-two healthy women of similar age and ethnic composition served as control subjects. In all subjects, the proportions of mineralized bone, osteoid, and porosity (nonbone soft tissue) were measured separately in cortical and cancellous bone tissue, from intact full-thickness biopsies of the ilium, representative of the axial skeleton. The results were related to the volumes of cortical and cancellous bone tissue separately and to the volume of the entire biopsy core. Approximately three-quarters of the patients had measurements in the appendicular skeleton by single photon absorptiometry of the radius and morphometry of the metacarpal. Disease effects did not differ significantly between ethnic groups. Mineralized cortical bone volume (per unit of core volume) was reduced by approximately 45% in both patient groups. Mineralized cancellous bone volume was significantly increased by 36% in the patients with OF and nonsignificantly reduced by 9% in the patients with OM; however, the reduction in the latter patients was significant in relation to tissue volume. The combined total deficit for both types of iliac bone was approximately 20% in the patients with OF and approximately 40% in the patients with OM. Significant reductions in appendicular cortical bone were demonstrated in both patient groups at both measurement sites. Regardless of the current histologic classification, the major structural abnormality in the skeleton is generalized thinning of cortical bone due to increased net endocortical resorption, the most characteristic effect on bone of hyperparathyroidism. Protection of the skeleton from the adverse consequences of renal failure will require therapeutic intervention in patients with no symptoms of either renal or bone disease.

Osteogenic protein-1 (bone morphogenetic protein-7) reduces severity of injury after ischemic acute renal failure in rat

We have shown that osteogenic protein-1 (OP-1) (bone morphogenetic protein-7) is responsible for the induction of nephrogenic mesenchyme during embryonic kidney development. Gene knock-out studies showed that OP-1 null mutant mice die of renal failure within the first day of postnatal life. In the present study, we evaluated the effect of recombinant human OP-1 for the treatment of acute renal failure after 60 min bilateral renal artery occlusion in rats. Bioavailability studies in normal rats indicate that approximately 1.4 microg OP-1/ml is available in the circulation 1 min after intravenous administration of 250 microg/kg, which then declines steadily with a half life of 30 min. About 0.5% of the administered OP-1 dose/g tissue is targeted for OP-1 receptors in the kidney. We show that OP-1 preserves kidney function, as determined by reduced blood urea nitrogen and serum creatinine, and increased survival rate when administered 10 min before or 1 or 16 h after ischemia, and then at 24-h intervals up to 72 h after reperfusion. Histochemical and molecular analyses demonstrate that OP-1: (a) minimizes infarction and cell necrosis, and decreases the number of plugged tubules; (b) suppresses inflammation by downregulating the expression of intercellular adhesive molecule, and prevents the accumulation and activity of neutrophils; (c) maintains the expression of the vascular smooth muscle cell phenotype in pericellular capillaries; and (d) reduces programmed cell death during the recovery. Collectively, these data suggest that OP-1 prevents the loss of kidney function associated with ischemic injury and may provide a basis for the treatment of acute renal failure.

Recombinant human osteogenic protein-1 (OP-1) stimulates periodontal wound healing in class III furcation defects

Osteogenic protein-1 (OP-1) is a member of the transforming growth factor beta superfamily and is a potent modulator of osteogenesis and bone cell differentiation. This preclinical study in dogs sought to assess the effects of OP-1 on periodontal wound healing in surgically created critical size Class III furcation defects. Eighteen male beagle dogs were subjected to the creation of bilateral mandibular 5 mm osseous defects. A split-mouth design was utilized which randomly assigned opposing quadrants to control therapy (surgery alone or collagen vehicle) or 1 of 3 ascending concentrations of OP-1 in a collagen vehicle (0.75 mg OP-1/g collagen, 2.5 mg/g, or 7.5 mg/g). Thus, 9 quadrants per test group received OP-1, 9 quadrants per control group received surgery alone, and 9 quadrants received collagen vehicle alone. Test articles were delivered by a surgeon masked to the treatment, and fluorogenic bone labels were injected at specified intervals post-treatment. Eight weeks after defect creation and OP-1 delivery, tissue blocks of the mandibulae were taken for masked histomorphometric analysis to assess parameters of periodontal regeneration (e.g., bone height, bone area, new attachment formation, and percent of defect filled with new bone). Histomorphometry revealed limited evidence of osteogenesis, cementogenesis, and new attachment formation in either vehicle or surgery-alone sites. In contrast, sites treated with all 3 concentrations of OP-1 showed pronounced stimulation of osteogenesis, regenerative cementum, and new attachment formation. Lesions treated with 7.5 mg/g of OP-1 in collagen regenerated 3.9+/-1.7 mm and 6.1+/-3.4 mm2 (mean +/-S.D.) of linear bone height and bone area, respectively. Furthermore, these differences were statistically different from both control therapies for all wound healing parameters (P < 0.0001). No significant increase in tooth root ankylosis was found among the treatment groups when compared to the surgery-alone group. We conclude that OP-1 offers promise as an attractive candidate for treating severe periodontal lesions.

Effects of different regimens of sodium fluoride treatment for osteoporosis on the structure, remodeling and mineralization of bone

We compared initial and final bone histomorphometric findings in 66 osteoporotic patients treated with sodium fluoride (NaF) according to three regimens, and in 7 osteoporotic patients who did not receive NaF. Fourteen patients received continuous NaF 75 mg/day (high-dose) with calcium 1500 mg/day for a mean of 41 months. Twenty-six patients received continuous NaF 50 mg/day (low-dose) with calcium 2000 mg/day for a mean of 15 months, either with (10 patients) or without (16 patients) vitamin D. Twenty-six patients received cyclical low-dose NaF, alternating with vitamin D, for a mean of 15 months and a total treatment duration of 28 months, of whom 14 were and 12 were not on NaF at the time of the second biopsy. Disregarding differences between regimens, there were significant increases in total and mineralized bone volume and trabecular thickness and nonsignificant decreases in these measurements in the control group. Fluoride-induced bone formation was exclusively appositional with no evidence for the creation of new trabeculae. The effect of low-dose NaF on bone structure was the same when the same total dose was given continuously or intermittently, and when the patient was or was not taking vitamin D. The increases in total and mineralized bone volume but not trabecular thickness were greater with high-dose than with low-dose NaF. Low-dose NaF caused modest but significant increases in all osteoid indices, and modest but significant declines in adjusted apposition rate and osteoid maturation rate and no change in bone formation rate. With high-dose NaF, the increase in BV/TV was greater but all indices of osteoid accumulation were much higher and all indices of impaired osteoblast function and mineralization were much lower, and 12 of 14 patients had some form of osteomalacia. This occurred also in 3 of 30 patients treated with low-dose NaF who were not taking vitamin D; the mean increase in osteoid thickness was significantly greater in these patients than in 22 low-dose patients who were taking vitamin D. We conclude: (1) The inconsistent effect of NaF in increasing bone strength is partly due to failure to restore connectivity in patients with severe bone loss and partly due to substantial osteoid accumulation. (2) Even low-dose NaF causes impaired osteoblast function, but this is much greater with high-dose prolonged therapy. (3) There is an unexplained discrepancy between the increase in bone formation implied by increases in spinal bone mineral and the lack of increase in bone formation measured histomorphometrically. (4) Defective mineralization is more closely related to the total cumulative dose of NaF than to the duration of treatment, and with low-dose treatment may be preventable by vitamin D. (5) Future clinical trials should be carried out with smaller doses of NaF and before there has been substantial loss of horizontal trabeculae in the spine.

Effects of ethnicity and age or menopause on osteoblast function, bone mineralization, and osteoid accumulation in iliac bone

We measured histologic indices of osteoblast function, bone mineralization, and osteoid accumulation separately on the cancellous, endocortical, and intracortical subdivisions of the endosteal envelope and on the combined total surface in transiliac biopsies obtained after double tetracycline labeling in 142 healthy women, aged 20-74 years, 34 who were black (19 pre- and 15 postmenopausal) and 108 white (42 pre- and 66 postmenopausal). The data were subjected to two-way analysis of variance of the four groups defined by age/menopause and ethnicity. Also, linear regressions of selected variables on age and between functionally related but independently measured variables were examined. None of the interaction terms was significant, and none of the regression slopes on age differed between blacks and whites, indicating that, as for the previously reported structural and remodeling indices, the effects of ethnicity and of age/menopause are independent. Accordingly, the data were analyzed separately for the effects of ethnicity (pre- and postmenopausal combined) and age/menopause (blacks and whites combined). The analyses led to the following conclusions (1) Osteoid surface and volume were higher and adjusted apposition rate and osteoid mineralization rate lower in postmenopausal than in premenopausal subjects, but none of the indices of osteoid accumulation differed between blacks and whites. (2) Each index of osteoid accumulation was significantly correlated with its primary independently measured kinetic determinant (osteoid thickness with adjusted apposition rate, osteoid surface/bone surface with activation frequency, and osteoid volume/bone volume with bone formation rate/bone volume). None of the regression parameters differed significantly between blacks and whites. (3) The ratio of mineralizing surface to osteoid surface (MS/OS) was substantially lower in all demographic groups than could be accounted for by the later onset of mineralization than of matrix apposition at individual bone forming sites. (4) The low values for MS/OS can be explained by terminal mineralization being too slow to trap enough tetracycline molecules to produce detectable fluorescence, and do not require that mineralization be interrupted. (5) MS/OS was about 25% lower in blacks than in whites on all surfaces with corresponding differences in derived indices based on MS/OS, including adjusted apposition rate, mineralization lag time, and formation period. (6) The lower values for MS/OS in blacks are most likely due to slower terminal mineralization. This could not be accounted for by a lower serum level of calcidiol, but is consistent with the reported effect of reduced bone blood flow. (7) All differences in bone cell function between blacks and whites that we have observed could be the result of the ethnic, and presumably genetic, difference in bone accumulation during growth. Higher bone mass would result in less fatigue microdamage, less need for repair by directed bone remodeling, lower bone turnover, lower bone blood flow, and slower terminal mineralization. (8) If this explanation is correct, there are no fundamental differences in the biology of bone remodeling between ethnic groups.

Short-term oral phosphate and bone remodeling in beagles

Attempts to increase bone volume in osteoporotic patients are still in the experimental stage. The coherence therapy, proposed by Frost, suggests that the activated bone units can remodel bone matrix in tandem. The cells (i.e., osteoclast and osteoblast which compose the remodeling units) are manipulated through specific medications timed to each of their duration of actions. The current study was to examine the effect of withdrawal of oral phosphate on bone in ovariectomized dogs. The present report demonstrates the capability of short-term oral phosphate to activate bone remodeling in the ovariectomized animal model. Results from biochemical and histomorphometric analyses confirm that remodeling units are activated following the release of parathyroid hormone. This transient scenario inflicts a shift of mineral density distribution in cancellous bone matrix of the iliac crest. Nevertheless, the bone remodeling units appear to be synchronized with each other and thus their resorptive and formative phases should be amenable to further pharmacological manipulation.

A unique case of adult hypophosphatemic osteomalacia

A 36-year-old Russian man presented with neck and low back pain in September 1990. He was of normal stature, and there were no stigmata of rickets. The family history was negative for bone disease. He was found to have hypophosphatemia (2.3 mg/dl), impaired phosphate reabsorption (TmP/GFR 2.08), hyperphosphatasemia (254 IU/l), normocalcemia, normal vitamin D metabolite levels, and secondary hyperparathyroidism. Clinically, his spinal movements were quite impaired and there was moderate proximal muscle weakness. On skeletal radiographs, there was generalized osteosclerosis and multiple ligamentous calcifications. Transiliac biopsy was diagnostic for severe osteomalacia. He was treated with oral phosphate (240 mEq daily) and calcitriol (4 micrograms daily) with resultant very slow clinical, biochemical, and histomorphologic improvement. The patient had hypophosphatemic osteomalacia with some features of X-linked hypophosphatemia, but sporadic and of relatively late onset. The osteopenia, height loss, incapacitating weakness, and glycinuria that are characteristics of sporadic adult onset nonfamilial hypophosphatemia, with or without an associated tumor, and the low serum calcitriol levels that may be an additional characteristic of tumor-induced osteomalacia were absent. Other known causes of acquired renal tubular dysfunction were ruled out. The etiology, pathogenesis, and nosology of the disorder remain obscure, but treatment based on experience with other forms of hypophosphatemic osteomalacia was ultimately effective.

Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia

BACKGROUND AND METHODS

Anemia is common in patients with chronic renal insufficiency and secondary hyperparathyroidism. Erythropoietin therapy is effective, but the dose required varies greatly. One possible determinant of the efficacy of erythropoietin therapy is the extent of marrow fibrosis caused by hyperparathyroidism. We examined the relation between the erythropoietic response to erythropoietin and hyperparathyroidism in a cross-sectional study of 18 patients undergoing hemodialysis who had received erythropoietin therapy for one to three years. In 7 patients (the poor-response group), the dose of intravenous erythropoietin needed to maintain a mean (+/- SD) target hematocrit of 35 +/- 3 percent was > 100 units per kilogram of body weight three times a week, and in 11 patients (the good-response group) it was < or = 100 units per kilogram. In all patients, indexes of the adequacy of dialysis and the extent of hyperparathyroidism and aluminum toxicity were determined monthly, and bone histomorphometry was performed.

RESULTS

The mean (+/- SD) dose of erythropoietin required to maintain the target hematocrit was 174 +/- 33 units per kilogram three times a week in the poor-response group and 56 +/- 18 units per kilogram in the good-response group. The mean ages, duration and adequacy of dialysis, increment in hematocrit, iron requirements, and serum concentrations of calcium, phosphate, and aluminum were similar in the two groups. The percentages of osteoid volume and surface, the osteoid thickness, and the stainable aluminum content of bone were similar in the two groups. In contrast, the mean serum parathyroid hormone concentration, the percentages of osteoclastic and eroded bone surfaces, and the degree of marrow fibrosis were greater in the poor-response group than in the good-response group (P = 0.03, P = 0.04, P = 0.009, and P = 0.009, respectively).

CONCLUSIONS

In patients with uremia, the dose of erythropoietin needed to achieve an adequate hematocrit response may depend on the severity of secondary hyperparathyroidism and the extent of bone marrow fibrosis.

Producing frozen sections of calcified bone

We describe a procedure for the rapid production and maintenance of fresh frozen bone biopsies which can be used for a variety of immunohistochemical techniques. Within 5 min of excision, tissue is placed in cold 5% polyvinyl alcohol, surrounded with 3% carboxymethylcellulose in a hand made aluminum foil embedding mold and frozen by immersion in an absolute ethanol/dry ice slurry at -70 C. The tissue block is attached to the specimen stub with cryocompound and installed in a -32 C cryostat whose tungsten carbide D profile knife is maintained at -70 C. Automatic controls are set at a slow cutting speed and the "sectioning window" is adjusted to fit the biopsy size. Knife angle, thickness gauge and antiroll bar are changed to produce a complete section. The block face is smoothly "papered" with a polyvinylpyrrolidone (PVP) impregnated Ross lens paper strip. A single section is cut and positioned on a sequentially numbered, acid cleaned, double dipped chrome-alum gelatin coated slide; adhesion is aided by "press-blotting" with bibulous paper. Sections are stored at -20 C or in a desiccator at room temperature. A brief fixation followed by removal of the water soluble PVP and lens paper generates fresh frozen bone sections suitable for further analysis.

Bone resorption and formation on the periosteal envelope of the ilium: a histomorphometric study in healthy women

Continuation of net periosteal bone gain after cessation of longitudinal growth has been inferred from sequential radiographic morphometry. Accordingly, we performed histomorphometry of the periosteal surfaces of transilial bone biopsies from 57 healthy women aged 24-74 years, 29 premenopausal and 28 postmenopausal. Compared to the endocortical surface, the extents of eroded and osteoid surfaces were very similar, but the extents of osteoclast- and osteoblast-covered surfaces were 80-90% smaller, and both wall thickness and osteoid thickness were about 30% lower. Double tetracycline labels were present in only 11 cases. The second (demethylchlortetracycline) label was almost four times as long as the first (oxytetracycline) label, a much greater difference than on the endocortical surface, so that the extent of mineralizing surface was based only on the second label. Even so, adjusted apposition rates and bone formation rates were only about 20% of the endocortical values, and unlike the endocortical surface, formation rates were not higher in the postmenopausal than in the premenopausal women. Resorption, reversal, and formation periods were each much longer than on the endocortical surface. There was no correlation between periosteal and endocortical values for any variable. At least 54% of total cement line length was scalloped, implying reversal of remodeling direction from resorption to formation, and at least 18% of total cement line length was smooth, implying temporary arrest of bone formation. Convincing evidence of modeling, related to growth or mechanical stimulation, was not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone structure and calcium metabolism in obese Zucker rats

Obesity is associated with altered bone mass. However, reports on bone status in obesity are inconsistent. Increased or normal bone mass was reported in obese adults but decreased bone mineral content was described in obese children. Therefore we evaluated the obese fa/fa rat as a possible model to assist in studies of bone metabolism in obesity. Obese and lean 14-week-old male rats underwent 24 h balance studies for calcium, magnesium and phosphate. Plasma calcium, magnesium, phosphate, immunoreactive parathyroid hormone, urinary cAMP (cyclic adenosine monophosphate) and femur bone histomorphometry were also analysed. Obese rats were heavier and had higher plasma insulin, cholesterol and triglycerides levels (P less than 0.05). A comparable positive balance for calcium, magnesium and phosphate was found in obese and lean rats. Total plasma calcium was higher in the obese, but albumin corrected calcium and plasma magnesium, phosphate and glucose were similar to the lean. In contrast to human obesity, obese rats were hypercalciuric, hypermagnisuric and hyperphosphaturic (P less than 0.05). iPTH and urinary cAMP were higher in the obese. Femora of fa/fa rats were shorter and lighter. Their bone osteoid surface and bone calcium content were similar to controls. Femora metaphysis in the obese had increased number of trabeculae, decreased trabecular width and higher erosion surface/bone surface ratio. Their diaphysis had increased cortical area/bone area and cortical width/bone width ratios and decreased medullary area. In summary, obese rats have higher iPTH, are hypercalciuric and have decreased bone mass. These last two observations differ from what is described in adult human obesity. Therefore, the obese fa/fa rat is of limited assistance in studies of bone status in adult human obesity. It might be of help in studies of bone metabolism in juvenile obesity.

A new method for measuring cancellous bone erosion depth: application to the cellular mechanisms of bone loss in postmenopausal osteoporosis

We have devised a new method for measurement of final depth of erosion in cancellous bone with an intra-individual precision of 4.3% and applied it to determine the mechanism of continuing reduction in trabecular thickness after menopause. Mean erosion depth (SD) was 40.8 (2.0) microns in 10 healthy postmenopausal women and 41.4 (2.1) microns in 10 age-matched patients with postmenopausal osteoporosis; the difference was not statistically significant. In contrast, wall thickness, using a method based on density differences between new and old bone, was 39.5 (2.0) microns in the normal subjects and 35.3 (2.0) microns in the patients with osteoporosis (p less than 0.0001). The balance per remodeling cycle (delta BMU) was -1.34 (2.49) microns in the normal subjects and -6.11 (1.95) microns in the patients with osteoporosis. This difference was also highly significant (p less than 0.001). Indirect estimations of erosion depth and delta BMU, based on the fall in trabecular thickness from an assumed premenopausal value of 147 microns and the number of remodeling cycles accumulated since menopause, agreed closely with the measured values. Erosion depth measured by the Eriksen method also showed no significant difference between the two groups, but because the values were substantially higher delta BMU was improbably high in both groups, did not differ significantly between groups, and was inconsistent with the observed difference in trabecular thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural and geometric changes in iliac bone: relationship to normal aging and osteoporosis

We measured indices of bone volume (cancellous and cortical) and bone surface (cancellous, endocortical, and intracortical) in intact, full-thickness transiliac bone biopsies obtained from 47 healthy white women (23 premenopausal and 24 postmenopausal) and 82 patients with postmenopausal osteoporosis. In the normal subjects there was the expected loss of cancellous bone with age, best shown by a reduction in bone surface/tissue volume, but no fall in cortical thickness with age despite a significant reduction in forearm bone density measured by single-photon absorptiometry. Bone surface/bone volume was about four times higher in cancellous than in cortical bone, and cancellous bone contributed about one-third of the total bone volume and about two-thirds of the bone surface when related to the core volume referent. In the osteoporotic patients, core width, an index of iliac bone thickness at the biopsy site, was reduced by 10%, but we could not determine whether this was the result of compaction of the core or of bone slenderness. All indices of bone volume, cortical as well as cancellous, were significantly smaller, as were the values for forearm bone densitometry; the relative deficits at different sites depended on whether they were expressed as percentages or as zeta scores. Bone surface/bone volume was increased in both cancellous and cortical bone, but bone surface/tissue volume was reduced in cancellous bone and increased in cortical bone. The proportions of total bone volume and surface contributed by cancellous and cortical bone were almost the same as in normal postmenopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)

Difference in label length between demethylchlortetracycline and oxytetracycline: implications for the interpretation of bone histomorphometric data

We measured the individual lengths of fluorescent labels on the three subdivisions of the endosteal envelope in iliac bone biopsy specimens produced by the administration of both oxytetracycline and demethylchlortetracycline. Fifty-one healthy subjects and 53 patients with postmenopausal osteoporosis were labeled in the stated order, and 8 osteopenic patients were labeled in the reverse order. Whatever the order of administration, the demethylchlortetracycline label was longer than the oxytetracycline label. We conclude: (1) the difference in label lengths reflects a difference between the two compounds in some intrinsic property, whether physical, chemical, or pharmacokinetic. (2) If the calculation of extent of mineralizing surface is based on the mean length of the two labels, a suitable correction should be applied to the shorter label; alternatively, the length of the longer label alone should be used. (3) Unlabeled osteoid not due to label escape probably results from slow terminal mineralization after cessation of matrix synthesis during which too few tetracycline molecules are incorporated to exceed the threshold for visible fluorescence, rather than from the temporary interruption of mineralization followed by its resumption.

Idiopathic acquired diffuse osteosclerosis in a young woman

We describe a young woman who acquired a painful, diffuse osteosclerosis of the cervical, thoracic, and lumbar spine, pelvis, and long bones of the legs as an adult. Bone densitometry showed a large increase in apparent bone density. Skeletal radiographs demonstrated progressive endosteal and periosteal thickening of the cortices. A bone scan showed increased uptake of radiolabel. The serum total alkaline phosphatase and 1,25-(OH)2D3 levels were substantially elevated and the immunoreactive PTH was mildly elevated. Bone biopsy showed increased bone turnover, especially on endocortical and intracortical surfaces, but the structural indices were normal. By 4 years after presentation the bone pain had remitted and the serum alkaline phosphatase, 1,25-(OH)2D3, and PTH were normal. No cause for the occurrence of osteosclerosis in this patient could be found.

Frequency distributions of tetracycline-based measurements: implications for the interpretation of bone formation indices in the absence of double-labeled surfaces

The frequency distributions of mineral apposition rate (MAR) and mineralizing surface (MS), measured separately on the intracortical, endocortical, and cancellous surfaces in 46 normal subjects and 79 patients with postmenopausal osteoporosis, indicated that MAR has a finite lower limit of 0.3 mu/day (uncorrected for section obliquity) but that MS has no finite lower limit. We conclude that in the absence of labels MAR, and indices derived from it, must be treated as missing values, but that MS and indices with MS in the numerator should be allowed to take values of zero. To avoid infinite values for indices with MS in the denominator, we propose that osteoid mineralization rate (the reciprocal of mineralization lag time) and osteoblast vigor (the reciprocal of formation period) be used instead. For surfaces with genuine single labels (SL) but no double labels, we propose that MS is calculated as SL/2 and that for MAR either the lower limit of 0.3 or the mean measured value from other surfaces be used for calculating derived indices.

The effects of chronic dietary calcium supplementation on bone mineral density in ovariectomized beagles

Oral calcium tablets were given daily for 180 days to ovariectomized Beagle dams (n = 4). Total serum calcium, and bone mineral content of midshaft femur were measured and compared to that of the controls (ovariectomized alone, n = 4). The bone mineral density was significantly higher in the calcium supplemented dogs (p less than 0.01).

Systemic effects of prostaglandin E2 on vertebral trabecular remodeling in beagles used in a healing study

Prostaglandin E2 (PGE2) at a dose of 10 mg/kg was administered orally to beagles used in a study of rib fracture and drill hole defect healing. Double fluochrome labels were given prior to surgical manipulation and before necropsy at 30 days. Bone remodeling was evaluated in trabecular bone of the fourth lumbar vertebra. There was a decrease in the number and extent of posttreatment labels (P less than 0.05) in the controls, with decreased mineral apposition rate (P less than 0.05) and decreased active bone formation rate (P less than 0.01). In dogs given PGE2 for 30 days following surgery, the extent of posttreatment labels (P less than 0.05) and bone formation rate (P less than 0.01) were increased. There was no difference found, however, in static morphometric parameters, including osteoid and osteoblast-covered surface, indicating that the stimulation of bone formation may have been transitory and matrix synthesis had declined. In another group of dogs given PGE2 for 5 days prior to surgical manipulation and between the first and second pretreatment labels, the extent of the double-labeled surface was increased (P less than 0.05) indicating an acute PG effect to sustain formation at remodeling sites. These studies show that PGE2 given orally has a systemic effect on bone remodeling in vertebral trabeculae that involves the stimulation of formation activity.

Effect of PGE2 on regional cortico-endosteal remodeling in beagles with fractured ribs: a histomorphometric study

A histomorphometric study was done on healing defects in the ribs of Beagles. A transverse fracture was made in the left 9th and 10th ribs. Beagles were given either ethanol vehicle (n = 6) or prostaglandin E2 (PGE2) orally (n = 5) for the 30-day period after surgical manipulation to time of necropsy. Double fluorescent labels were given to measure bone matrix mineralization. Two fluorochrome markers were used: calcein before dogs were surgically manipulated and oxytetracycline HCl before they were killed. The two objectives of the present study were: (1) to determine the effects of fracture on regional cortico-endosteal remodeling 2 cm from a fracture site in the ribs of Beagles; and (2) to determine the effects of orally administered PGE2 on the above condition. The results suggested that the fractured and the non-fractured ribs in either group show a similar static and dynamic remodeling during the first 30 days of healing. The activation frequency in the PGE2 group was increased in both fractured and non-fractured ribs more than in the non-treated group. Therefore, the systemic administration of PGE2 can activate and synchronize remodeling cycles among BMUs.

Does "hepatic osteodystrophy" differ from peri- and postmenopausal osteoporosis? A histomorphometric study

Bone remodeling activities were assayed on undecalcified sections of iliac crest biopsies obtained from patients with primary biliary cirrhosis (PBC) (n = 25), postmenopausal osteoporosis (n = 64), and age, sex-matched, nonosteoporotic peri- and postmenopausal subjects (n = 26). Thorough semiautomated static and dynamic bone histomorphometry was carried out. Statistical analysis was performed among the age-matched groups in 10-year intervals through the ages 45 to 74. No osteomalacia or osteoporotic condition was detected in the patients with PBC. Our data have shown they did not have a mineralization defect but rather high bone turnover rates. The discrepancy of our observations to other published studies is discussed. We suggest that the osteoporotic condition attributed by others to PBC may just be the result of the concomitant aging processes.

Effect of prostaglandin E1 on the periosteal regional acceleratory phenomenon in fractured ribs: histomorphometric study in beagles

Transverse fractures were made surgically in the midshaft of the left 9th and 10th ribs in adult Beagles. A buffer vehicle (n = 4) or 0.2 mg of prostaglandin (PG) E1/day (n = 6) was injected into the fracture sites twice a day for 10 days, and dogs were euthanatized on day 30. Double-pulsed fluorescent labels were given with each of 2 fluorochrome markers--calcein before surgical treatment and oxytetracycline HCl before euthanasia. Histomorphometric analysis was carried out on specimens collected in adjacent regions of the healing defects. The surface extent and width of the osteoid on fractured (P less than 0.01, P less than 0.05, respectively) and nonfractured (P less than 0.05) sites in the treated group were greater than those in the nontreated group. The net loss of mineralizing surfaces was noticed on both ribs of both groups. Of 11 samples on the fractured side in the treated group, 4 contained periosteal new bone proliferation. There was increased osteoid formation and decreased mineralizing surfaces in the PGE1-treated group. Seemingly, administration of PGE1 induced bone matrix formation on periosteal envelope adjacent to a fracture site and its contralateral matching site.

Effect of prostaglandin E1 on regional haversian remodeling in beagles with fractured ribs: a histomorphometric study

A histomorphometric study was carried out on healing defects in the ribs of beagles. A transverse fracture was made surgically in the midshaft of the left 9th and 10th ribs. Ten beagles received injections of either a buffer vehicle (n = 4) or prostaglandin E1 (PGE1) at a dose of 0.4 mg/day locally (n = 6) into the fracture sites for a 10-day period and were killed 30 days after the surgery. Double-pulsed fluorescent labels were given with each of two fluochrome markers, calcein before surgical treatment and oxytetracycline hydrochloride before killing. The objectives were to determine manifestations of the regional acceleratory phenomenon (RAP) as changes in regional remodeling in the haversian envelope induced by fracture, effects of PGE1 on modification of the RAP in the haversian envelope, and systemic effects of PGE1 on remodeling changes of the contralateral matching sites. The differences in haversian remodeling between the injured and uninjured ribs of the experimental dogs indicated an increase in activation frequency, that is, regional acceleratory phenomenon. The significant effect of PGE1 on enhancing fracture-induced acceleration of haversian remodeling was doubtful, because of the preexistent biologic differences found in the two experimental groups. Nevertheless, the two groups shared a similar pattern of remodeling activity. The posttraumatic mineralization that declined at the sampled sites need further investigation.

Effects of prostaglandins on regional remodeling changes during tibial healing in beagles: a histomorphometric study

A histomorphometric study was carried out on bone samples in the region of healing defects in the tibias of beagles of various ages. A 5 mm diameter drill hole defect was made in the mid-shaft of the tibia. Eleven of the beagles received either vehicle (n = 6) or prostaglandin E2 orally (n = 5) for the 30-day period from surgery to time of necropsy. Ten dogs received local injections of vehicle (n = 4) or prostaglandin E1 directly into the defects for the first 10 days after surgery. Double labels were given with each of two fluochrome markers, calcein prior to surgical treatment, and oxytetracycline hydrochloride prior to 30-day sacrifice. The regional remodeling changes were evaluated in 40-50 micron thick cross-sections taken 2 cm proximal to the defect and matching samples from the contralateral side. In the controls, the changes were variable and reflected primarily increased formation on the surfaces of the cortex. Cortical endosteal bone formation, as indicated by oxytetracycline labeling, was increased in both control groups and there was an increase in labeling in the periosteal and haversian envelopes as well, in the local injection control group. In the dogs given prostaglandin E2 orally, there was increased periosteal bone formation in addition to increased cortical-endosteal formation. When healing sides were compared to controls, prostaglandin E2-treated dogs also had increased osteoid formation in all three envelopes and increased resorption surface in the cortical endosteal envelope, indicating accelerated remodeling.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of prostaglandin E2 on rib fracture healing in beagles: histomorphometric study on periosteum adjacent to the fracture site

A histomorphometric study was done on healing defects in the ribs of Beagles. A transverse fracture was made in the left 9th and 10th ribs. Beagles were given either ethanol vehicle (n = 6) or prostaglandin (PG) E2 orally (n = 5) for the 30-day period after surgical manipulation to time of necropsy. Double fluorescent labels to measure bone matrix mineralization were given with each of 2 fluorochrome markers--calcein before dogs were surgically manipulated and oxytetracycline hydrochloride before they were euthanatized. The objectives were to determine the effects of fracture on regional remodeling in the periosteum, the effects of PGE2 on the regional remodeling changes in the periosteum induced by the fracture, and the systemic effect of PGE2 on remodeling changes of the contralateral matching sites. The fracture in the nontreated dogs (ethanol only) stimulated remodeling activity in the periosteum with increased resorption (P less than 0.01). However, after surgical manipulation (necropsy) was done, the extent of mineralization on the bone surface was decreased and was decreased more on the nonfractured ribs (right side) than on the fractured (healing) ribs (left side) (P less than 0.05). In the treated dogs, the administration of PGE2 increased the extent of mineralization on the bone surface on the healing ribs. However, as in the nontreated dogs, the administration of PGE2 did not alter the decreasing pattern of mineralization when comparing the bone surfaces at necropsy with the bone surfaces before surgical manipulation was done.(ABSTRACT TRUNCATED AT 250 WORDS)

Sarcoma and helper-specific RNA tumor virus subunits in transformed nonproducer mouse cells activated to produce virus by treatment with bromodeoxyuridine

A tumor line (58-2T) was established from a slowly growing tumor in a BALB/c mouse inoculated with M58-2 cells. The latter clonal cell line was isolated after bromodeoxyuridine treatment as a flat variant from nonproducer BALB/3T3 cells transformed by the Kirsten sarcoma virus. The 58-2T cells produced type C virus with two discrete virus-specific RNA species. One of the species, which was probably an endogenous virus RNA subunit, had a sedimentation coefficient of 35S as the largest major subunit, and had sequences similar to Rauscher leukemia virus RNA based on nucleic acid hybridization. The other RNA species had 30S as the largest major subunit and corresponded to Kirsten sarcoma virus-specific RNA. These two RNA species formed heterogeneous, 60 to 70S, high-molecular-weight RNA in virions.DNA transcripts (58-2T DNA) from the activated virus contained base sequences complementary to Rauscher leukemia virus and Kirsten sarcoma virus. The Kirsten sarcoma virus-specific DNA sequences (58-2TS) were purified from 58-2T DNA by eliminating RLV-specific sequences.