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Chromaticity type horizontal cells (C-type HCs) are the first retinal neurons exhibiting spectral information processing in cold-blooded vertebrates. The simple input of hyperpolarizing responses of cone photoreceptors is transformed in the C-type HCs into spectral opponent output. Nitric oxide (NO), a known background neuromodulator in the distal retina, was tested here for its effects upon spectral information processing by C-type HCs in the retina of turtle. Photoresponses were intracellularly recorded from C-type HCs, using light stimuli of different wavelength, applied over backgrounds of different wavelengths, and changing retinal NO level. Raising retinal level of NO in darkness by adding the precursor for its synthesis (l-Arginine) augmented the depolarizing photoresponses elicited by long-wavelength light stimuli, and reduced the hyperpolarizing photoresponses elicited by short-wavelength light stimuli. Lowering retinal level of NO by l-NAME, an inhibitor of NO synthesis, induced the opposite effects. However, the total voltage range of operation remained constant regardless of the level of NO. Qualitatively similar effects were observed under background illuminations regardless of background strength and wavelength. Altering retinal level of NO exerted a small effect upon the null wavelength. Our findings are consistent with the known effects of NO upon turtle distal retinal neurons, with the addition of NO strengthening the negative feedback pathway from L-type horizontal cells onto medium-wavelength cones. [ABSTRACT FROM AUTHOR]

Abstract: Treatment of postmenopausal osteoporosis comprises a major public health challenge requiring adherence to long-term therapy in order to prevent fractures and disability. The aim of this work was to assess long-term adherence to anti-osteoporosis treatments in Israeli postmenopausal women. We assessed 178 consecutive Metabolic Bone Diseases Unit patients, aged 67.4±8.5, treated with alendronate or raloxifene. Adherence was assessed at a clinic visit after 6 months and by telephone survey 2 years after starting the therapy. After 6 months 137 (77%) patients were adhered to the treatment; 41(23%) discontinued it. Two years after initiating the therapy 78 (43.8%) continued the treatment, 39 (21.9%) discontinued it, 17 (9.6%) changed the initial drug to another anti-osteoporosis therapy, 21 (11.8%) lost to follow-up. Of 41 patients reported treatment discontinuation at 6 months 17 (41.5%) restarted the treatment with one of the anti-resorbing medications. Age, family history of osteoporosis and previous fracture history have not influenced patients’ adherence. Conclusion: Two years after the initiation of fracture prevention treatment, it was discontinued by one fifth of the patients. Neither age nor disease-related factors such as family history of osteoporosis, previous fracture history or the degree of bone loss influenced patients’ decision to adhere to treatment. [Copyright &y& Elsevier]

Abstract: Achievement of adequate vitamin D3 level is crucial for the treatment of hip fracture patients. Currently used vitamin D3 supplementation in Israel ranges between 200 and 800IU/day. The study objectives were to evaluate the effects of 800IU/day vitamin D3 and 1.200mg of calcium carbonate supplementation to achieve adequate vitamin D3 level of 30ng/ml in elderly hip fracture patients. One hundred and twenty-two elderly patients after surgical hip fracture correction aged 73.0±9.5, who were enrolled in a post-surgical treatment program (PSTP). The patients received 800IU of vitamin D3 and 1.200mg of calcium carbonate daily. Serum 25(OH)D and plasma PTH levels were assessed during initial hospital stay and at quarterly follow-up visits for 2 years. At baseline, 120 patients (98.4%) had 25(OH)D serum level <30ng/ml. Forty-two patients (34.4%) had 25(OH)D serum level <10ng/ml and these were considered as vitamin D3 deficient. After 3 months, 29 patients (23.8%) were fully adherent to the supplement, 32 were (26.2%) partially adherent. The dropout rate at 1 year was 55.7%. The major reason for the discontinuation of participation was non-compliance. We conclude that the majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. Compliance with calcium and vitamin D3 supplements was extremely low. An adequate vitamin D status was not achieved with daily vitamin D3 supplementation of 800IU. Supplementation strategies using a periodic single high dose of vitamin D3 might be more appropriate and should be considered in these patients. [Copyright &y& Elsevier]

Abstract: In the present study we evaluated the possible contribution of different factors to the occurrence of hip fractures in Israel. We assessed medical history, physical activity, body mass index, smoking status, bone turnover markers and calcium regulating hormones levels of 142 consecutive elderly hip fracture patients (HFP), and compared them to 96 community dwelling elderly people without a history of hip fracture. Age and female gender were the strongest predictors of hip fracture, p <0.001 and 0.013. Stepwise logistic regression demonstrated that HFP had higher PTH and lower 25(OH)D3 levels, p =0.002, p <0.001; they were less physically active, p <0.001, and had higher rate of vitamin D insufficiency during winter–spring, compared to summer–autumn, p =0.033. Diabetics had higher risk for hip fracture, p =0.06, OR=3.9 (95% CI 1.50–10.4). Deoxypyridinoline (DPD) cross links levels were 19.35±10.58mg/mg creatinine in HFP and 9.12±3.52 in controls, p <0.0001. Bone alkaline phosphatase (BAP)/DPD ratio was 1.5 in controls compared to 0.53 in HFP. We conclude that age and female gender were the strongest predictors for hip fracture. Diabetic patients had threefold risk for hip fracture. Bone formation/bone resorption ratio was lower in HFP. Vitamin D deficiency and physical inactivity are important preventable risk factors for hip fracture. [Copyright &y& Elsevier]

Aim: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees. Patients and Methods: Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined. Results: Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33±2.32 mm (range 0.67–9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2±26.4). The mean 25(OH)D3 was 11.68±4.7, range 3.5–21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D3 levels ⩾30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment ( r=−0.474, p=0.03). A positive correlation was found between ABL, PTH ( r=0.419, p=0.059) and hip bone mineral density (BMD) ( r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD ( r=0.810, p=0.004). Conclusions: The majority of liver transplant patients had insufficient 25(OH)D3 serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Osteoporosis is a major cause of morbidity in liver transplant recipients and is associated with multiple factors. Objectives: To evaluate bone mineral density (BMD), bone turnover and calcium-regulating hormones in 29 patients (17 men, 12 women) 2–12 yrs following liver transplantation for non-alcoholic liver diseases. Results: Fifteen patients (52%) were on immunosuppressive treatment with tacrolimus and 14 (48%) with cyclosporine. Eleven patients (38%) were currently on prednisone, 18 patients (62%) had stopped glucocorticoid treatment 6 months to 11 yrs prior to the study. Nineteen patients (65.5%) had decreased BMD according to WHO criteria, 17 (58.2%) at the femoral neck, 13 (44.8%) at the lumbar spine. Nineteen patients (65.5%) had a subnormal (<15 ng/mL) serum level of 25 (OH) D3. These patients had significantly lower BMD at the femoral neck (p = 0.02). Femoral neck BMD negatively correlated with serum parathyroid hormone level (p = 0.06, r = -0.35), length of the post-transplantation period (p = 0.025, r = -0.416) and duration of glucocorticoid treatment (p = 0.029, r = -0.406), regardless of its cumulative dose. Symptomatic fractures were less frequent in tacrolimus treated patients than in cyclosporine users (p = 0.03). Conclusions: Decreased BMD is frequent following liver transplantation and is affected by vitamin D deficiency, cyclosporine use, and the duration of glucocorticoid therapy, but not by its cumulative dose. Achievement and maintenance of optimal vitamin D status and shortening of glucocorticoid treatment period may have a favorable effect on bone preservation. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the adherence of elderly hip fracture patients to vitamin D supplementation.

Introduction. Bisphosphonates prevent osteoporotic fractures in women younger than 80 years of age with documented osteoporosis. However adverse events related to these agents may affect the patients. There is a strong association between long-term use of bisphosphonates and occurrence of atypical femoral lesions and fractures. Our study investigates the awareness level of community physicians for early recognition and prevention of atypical femoral hip fractures in osteoporotic patients treated with bisphosphonates in three groups of physicians: General physicians, orthopedic surgeons and endocrinologists. Aim. The aim of this study is to examine the awareness level in these three groups and to suggest acts for early recognition and prevention of atypical hip fractures in patients using bisphosphonates. Methods. General physicians, orthopedic surgeons and endocrinologists were asked to anonymously fill a questionnaire checking their common knowledge regarding adverse effects associated with long-term use of bisphosphonates, optimal duration of treatment with bisphosphonates, recognition of atypical lesions or fractures, and prevention of further fractures. Results. The study involved 229 participants. The highest level of awareness was demonstrated by endocrinologists. On the other hand, lowest rates of awareness to clinical aspects, treatment options as well as ways of prevention of atypical fractures were found in the group of general physicians. In the orthopedic surgeons group some aspects of long-term use of bisphosphonates and atypical fractures were found to be poor. In summary, among all participants combined, a substantial knowledge gap was found in all aspect studied: 41.5% knowledge gap in questions regarding treatment, 39.5% in diagnosis issues, and 38% in regard to general familiarity with atypical lesions and fractures derived by bisphosphonate treatment. Conclusions. There is an obvious need to raise the awareness about the possibility of atypical hip lesions and fractures in patients treated with bisphosphonates which could contribute to early diagnosis of atypical femoral lesions and prevention of subsequent fractures. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a systemic skeletal disorder characterized by impaired bone quality and microstructural deterioration leading to an increased propensity to fractures. This is a major health problem for older adults, which comprise an increasingly greater proportion of the general population. Due to a large number of patients and the insufficient availability of specialists in Israel and worldwide, osteoporosis is treated in large part by primary care physicians. We assessed the knowledge of primary care physicians on the diagnosis and treatment of osteoporosis. Methods: Physician's knowledge, sources of knowledge acquisition and self-evaluation of knowledge were assessed using a multiple choice questionnaire. Professional and demographic characteristics were assessed as well. Results: Of 490 physicians attending a conference, 363 filled the questionnaires (74% response rate). The physicians demonstrated better expertise in diagnosis than in medications (mechanism of action, side effects or contra-indications) but less than for other treatment related decisions. Overall, 50% demonstrated adequate knowledge of calcium and vitamin D supplementation, 51% were aware of the main therapeutic purpose of osteoporosis pharmacotherapy and 3% were aware that bisphosphonates should be avoided in patients with impaired renal function. Respondents stated frontal lectures at meetings as their main source of information on the subject. Conclusion: The study indicates the need to intensify efforts to improve the knowledge of primary care physicians regarding osteoporosis, in general; and osteoporosis pharmacotherapy, in particular. [ABSTRACT FROM AUTHOR]

Non-typable Haemophilus influenzae (NTHi) is emerging as an important cause of invasive disease in immunized children. We describe a healthy, fully immunized 4-year old child who presented with bacteremia due to NTHi without overt acute otitis media (AOM), and subsequently developed severe mastoiditis complicated by sigmoid sinus thrombosis. Although, mastoiditis is typically regarded as a complication of AOM, those cases without antecedent AOM may represent an entirely different pathophysiological process with NTHi bacteremia seeding the mastoid. We present another example of the potential invasiveness of NTHi with a temporal sequence of events whereby NTHi bacteremia seeds the mastoid. This may represent novel sequelae of NTHi infection. [ABSTRACT FROM AUTHOR]

Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous noninvasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies. [ABSTRACT FROM AUTHOR]