Circulating vitamin D levels are associated with the presence and severity of coronary artery disease but not peripheral arterial disease in patients undergoing coronary angiography

BACKGROUND AND AIMS

To investigate the association between vitamin D levels, angiographic severity of coronary artery disease, arterial stiffness and degree of peripheral arterial disease (PAD) as assessed by ankle brachial index (ABI).

METHODS AND RESULTS

375 patients undergoing coronary angiography from November 2012 to September 2013 were recruited. Serum 25-hydroxyvitamin D (25OHD) levels were measured as were ABI and pulse wave velocity (PWV). Based on the findings of the coronary angiogram, patients were divided into subgroups: Absent, Single, Double and Triple Vessel Disease (as defined by >50% stenosis in each major coronary artery) 0.275 patients not taking vitamin D supplements were included in the analysis. Mean age was 66.0 ± 11.2 (mean ± SD) years. Levels of 25(OH)D were significantly lower in patients with CAD when compared to patients without CAD (57.0 ± 1.73 versus 70.1 ± 2.46 nmol/L; p < 0.01). One way ANOVA revealed triple vessel disease patients had significantly lower 25(OH)D levels when compared to single vessel disease patients (50.6 ± 2.84 nmol/L versus 61.3 ± 3.16 p < 0.01) and trended to be lower when compared to double vessel disease patients (50.6 ± 2.84 versus 59.0 ± 2.99 nmol/L; p = 0.07). Stepwise regression revealed that age, gender (male), hypertension, hyperlipidemia and 25(OH)D were significant predictors of CAD (p < 0.05). Vitamin D was the most significant predictor for CAD (p < 0.001) There was no correlation between 25(OH)D levels, ABI and PWV.

CONCLUSION

Among patients presenting for coronary angiography, low serum 25-hydroxyvitamin D levels are associated with the presence and extent of angiographic CAD but not arterial stiffness or PAD.

Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture

SUMMARY

A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended.

INTRODUCTION

The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s).

METHODS

The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations.

RESULTS

The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training.

CONCLUSIONS

The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional.

Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis

In an open-label extension study, BMD increased continuously with strontium ranelate over 10 years in osteoporotic women (P < 0.01). Vertebral and nonvertebral fracture incidence was lower between 5 and 10 years than in a matched placebo group over 5 years (P < 0.05). Strontium ranelate's antifracture efficacy appears to be maintained long term.

INTRODUCTION

Strontium ranelate has proven efficacy against vertebral and nonvertebral fractures, including hip, over 5 years in postmenopausal osteoporosis. We explored long-term efficacy and safety of strontium ranelate over 10 years.

METHODS

Postmenopausal osteoporotic women participating in the double-blind, placebo-controlled phase 3 studies SOTI and TROPOS to 5 years were invited to enter a 5-year open-label extension, during which they received strontium ranelate 2 g/day (n = 237, 10-year population). Bone mineral density (BMD) and fracture incidence were recorded, and FRAX® scores were calculated. The effect of strontium ranelate on fracture incidence was evaluated by comparison with a FRAX®-matched placebo group identified in the TROPOS placebo arm.

RESULTS

The patients in the 10-year population had baseline characteristics comparable to those of the total SOTI/TROPOS population. Over 10 years, lumbar BMD increased continuously and significantly (P < 0.01 versus previous year) with 34.5 ± 20.2% relative change from baseline to 10 years. The incidence of vertebral and nonvertebral fracture with strontium ranelate in the 10-year population in years 6 to 10 was comparable to the incidence between years 0 and 5, but was significantly lower than the incidence observed in the FRAX®-matched placebo group over 5 years (P < 0.05); relative risk reductions for vertebral and nonvertebral fractures were 35% and 38%, respectively. Strontium ranelate was safe and well tolerated over 10 years.

CONCLUSIONS

Long-term treatment with strontium ranelate is associated with sustained increases in BMD over 10 years, with a good safety profile. Our results also support the maintenance of antifracture efficacy over 10 years with strontium ranelate.

Measurement of short-range correlations in shock-compressed plastic by short-pulse x-ray scattering

We have performed short-pulse x-ray scattering measurements on laser-driven shock-compressed plastic samples in the warm dense matter regime, providing instantaneous snapshots of the system evolution. Time-resolved and angularly resolved scattered spectra sensitive to the correlation effects in the plasma show the appearance of short-range order within a few interionic separations. Comparison with radiation-hydrodynamic simulations indicates that the shocked plastic is compressed with a temperature of a few electron volts. These results are important for the understanding of the thermodynamic behavior of strongly correlated matter for conditions relevant to both laboratory astrophysics and inertial confinement fusion research.

Strontium ranelate prevents quality of life impairment in post-menopausal women with established vertebral osteoporosis

Strontium ranelate reduces the risk of fracture in post-menopausal osteoporotic women with prevalent fractures for whom quality of life is severely impaired. The SOTI study, which used the SF-36 questionnaire and disease-specific QUALIOST module, demonstrated that treatment with strontium ranelate improved osteoporotic women's quality of life compared with placebo.

INTRODUCTION

The Spinal Osteoporosis Therapeutic Intervention (SOTI) study demonstrated the effect of orally administered strontium ranelate versus placebo on the incidence of new vertebral fractures and compared impact on quality of life (QoL).

METHODS

QoL was assessed 6 monthly over 3 years using the QUALIOST and SF-36 questionnaires in post-menopausal osteoporotic women with prevalent fracture taking strontium ranelate or placebo 2 g/day. A total of 1,240 women were included (strontium ranelate: n=618 and placebo: n=622).

RESULTS

The QUALIOST total score decreased in the strontium ranelate group, indicating preserved QoL compared with a deterioration in the placebo group (P=0.016). Strontium ranelate patients had reduced QUALIOST emotional and physical dimension scores (P=0.019 and 0.032, respectively, versus placebo), indicating beneficial effects on emotional and physical functioning. There was a trend towards better SF-36 scores in the strontium ranelate group, although there were no significant between-group differences. More strontium ranelate patients (+31%) were free from back pain over 3 years versus placebo (P=0.005), with a significant effect from the first year of treatment (P=0.023).

CONCLUSION

Strontium ranelate has beneficial effects on QoL in women with post-menopausal osteoporosis compared with placebo.

Thomson scattering measurements of heat flux from ion-acoustic waves in laser-produced aluminum plasmas

Thomson scattering (TS) measurements are performed at different locations in a laser-produced aluminum plasma. Variations of the separation, wavelength shift, and asymmetric distribution of the two ion-acoustic waves are investigated from their spectral-time-resolved TS images. Detailed information on the space-time evolution of the plasma parameters is obtained. Electron distribution and variation of the heat flux in the plasma are also obtained for a steep temperature gradient.

Hip and ankle range of motion in elite classical ballet dancers and controls

OBJECTIVE

To report range of motion at the hip and ankle in male and female ballet dancers compared with controls.

DESIGN

Cross-sectional cohort study with convenience control sample.

SETTING

National classical ballet school in Australia.

PARTICIPANTS

Thirty-three female and 30 male full-time ballet students of mean (SD) age 16.9 (0.8) and 18.0 (1.4) years, respectively. Controls were 31 female and 16 male nondancing, normally active university students of average ages 18.8 +/- 0.6 and 18.8 +/- 0.9 years, respectively.

MAIN OUTCOME MEASURES

Degrees of range of motion of left and right sides for the following four movements: standing plié in parallel-passive ankle dorsiflexion (DF), standing turnout in the balletic first position-lower limb external rotation (LLER), supine hip external rotation (ER), supine hip internal rotation (IR). Two additional ranges of motion were calculated. External rotation below the hip joint (BHER) was derived by subtracting hip ER from LLER, and total supine hip rotation (Hip IR + ER) was derived by summing hip ER and hip IR.

MAIN RESULTS

On both left and right sides, dancers had greater LLER (p < 0.0001) and hip ER (p < 0.0001) but lesser hip IR than the controls (p < 0.0001). Female but not male dancers had greater total supine hip rotation (hip ER+IR) than controls (p < 0.05). There was no difference in either BHER or ankle DF between dancers and controls. Within dancers, females had greater range in both left and right hip IR, LLER, and hip IR + ER. There was no difference in hip ER. Regression analysis revealed that LLER related to hip ER in both males and females.

CONCLUSIONS

Elite classical dance students had greater hip external rotation (both ER and LLER) and less hip internal rotation than controls but similar BHER and ankle DF. Since ER below the hip joint and ankle DF do not differ between dancers and controls, despite repeated training of these movements in ballet, there may be anatomical (bony/ligamentous) limitations to these movements.

Overuse injuries in classical ballet

Successful management of classical ballet dancers with overuse injuries requires an understanding of the art form, precise knowledge of anatomy and awareness of certain conditions. Turnout is the single most fundamental physical attribute in classical ballet and 'forcing turnout' frequently contributes to overuse injuries. Common presenting conditions arising from the foot and ankle include problems at the first metatarsophalangeal joint, second metatarsal stress fractures, flexor hallucis longus tendinitis and anterior and posterior ankle impingement syndromes. Persistent shin pain in dancers is often due to chronic compartment syndrome, stress fracture of the posteromedial or anterior tibia. Knee pain can arise from patellofemoral syndrome, patellar tendon insertional pathologies, or a combination of both. Hip and back problems are also prevalent in dancers. To speed injury recovery of dancers, it is important for the sports medicine team to cooperate fully. This permits the dancer to benefit from accurate diagnosis, technique correction where necessary, the full range of manual therapies to joint and soft tissue, appropriate strengthening programmes and maintenance of dance fitness during any time out of class with Pilates-based exercises and nutrition advice. Most overuse ballet conditions respond well to a combination of conservative therapies. Those dancers that do require surgical management still depend heavily on ballet-specific rehabilitation for a complete recovery.

Neuronal intranuclear hyaline inclusion disease with progressive cerebellar ataxia

Neuronal intranuclear hyaline inclusion disease is a progressive, fatal neurologic condition characterized by eosinophilic inclusions in neurons of the central, autonomic, and peripheral nervous systems. The clinical and pathologic findings of a 4-year-old boy who presented with a rapidly progressive cerebellar ataxia and seizure disorder that had begun 2 years earlier are described. Although intraneuronal inclusions were identified in neurons of cortex, basal ganglia, brainstem, cerebellum, and spinal cord, clinical signs were restricted to cerebellar ataxia, internuclear ophthalmoplegia, and cognitive delay. Predominant cerebellar atrophy, early age of onset, and short clinical course distinguishes it from previously reported patients.

Conversion of an old gamma camera to a bone mineral densitometer

A 1974-vintage 25 cm field of view gamma camera was converted to a bone mineral densitometer using a purpose-built converging collimator with attached C-arm holding a 250 mCi gadolinium (Gd) 153 source. After addition of a second pulse-height analyser, increasing the high voltage gain and connecting to a digital computer, spinal and hip bone mineral density measurements were made. Accuracy of 2% and long-term reproducibility of 2.7% were obtained using an anthropomorphic bone phantom. For lumbar spine measurements in normal volunteers, long-term reproducibility was 3.2% and for osteoporotic (spinal fracture) patients (mean density 831 mg cm-2) reproducibility was 3.7%.

Evidence that muscarinic receptors in islet cells are not coupled functionally to adenylate cyclase through the inhibitory guanine nucleotide binding protein (Ni)

The effect of muscarinic agonist on adenylate cyclase was investigated in neonatal islet cells and in a clonal pituitary cell line (GH4C1) following labelling of the intracellular ATP pool with [2,8 3H]adenine. In islet cells carbamylcholine was without effect on basal or glucagon-stimulated adenylate cyclase activity, measured as 3H cyclic AMP production, but inhibited 3H cyclic AMP production in the clonal pituitary cells. The involvement of the inhibitory guanine nucleotide binding protein of adenylate cyclase (Ni) was investigated by the use of the Bordetella pertussis exotoxin, islet activating protein (IAP). Pre-treatment of islet cells with IAP was without effect on adenylate cyclase following carbamylcholine but in the clonal pituitary line abolished the inhibition of 3H cyclic AMP production. It is concluded that in the islet cell, in contrast to the clonal pituitary cell, muscarinic receptors are not effectively coupled through Ni to inhibit adenylate cyclase.

The heart attack and doctor/patient communication

In patients with recent proven or suspected myocardial infarction, understanding of the nature of a heart attack was explored. A wide range of misconceptions, some of them frightening, was revealed; there was a poor understanding of some terms commonly used in discussion with patients; the potential for creation of new misconceptions by doctors and nurses was highlighted.