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Introduction: Despite the high hopes for the use of transcranial magnetic stimulation (TMS) in the treatment of depression, between 30% and 60.5% of patients do not respond to stimulation. The factors contributing to non-response, especially those related to personality, remain insufficiently investigated. The main aim of our study was to compare the efficacy of active TMS and sham–placebo protocols in combined therapy of treatment-resistant depression with evaluation of possible personality disorders comorbidity. Methods: The study was conducted between December 2019 and December 2022, as a randomized, double-blind, active comparator-controlled and sham-controlled parallel trial. Patients (n = 41) were randomized into one of two experimental conditions (active TMS vs. placebo) and screened before and after stimulation as well as at a 3-month follow-up. Personality disorders were assessed with The Structured Clinical Interview for DSM-5 Personality Disorders. Results: There were no significant differences between the TMS active and sham groups in terms of general characteristics, coexisting personality disorders, and Montgomery–Åsberg Depression Rating Scale scores before stimulation, at the end of stimulation, and after 3 months of stimulation. However, linear regression analysis revealed significant negative associations between the coexistence of personality disorders and the reduction of depressive symptoms from baseline to the end of stimulation. The post-hoc exploratory analysis on the first phase of the RCT confirmed the presence of personality disorders to be a consistent negative influence on the reduction of depressive symptoms post-stimulation, regardless of protocol and experimental condition and demonstrated a smaller percentage reduction in depressive symptoms after stimulation in patients with personality disorders. Discussion: A central conclusion, based on our study, is that transcranial magnetic stimulation for treatment-resistant depression cannot be considered as a method independent of co-occurring personality disorders. [ABSTRACT FROM AUTHOR]

Asymptomatic primary hyperparathyroidism (PHPT) involves 80–90% of the parathyroid tumor-associated cases of PHPT in the modern medical era, while normocalcemic PHPT (NPHPT) has a prevalence of 0.1–11%. We aimed to analyze the bone status and mineral metabolism in NPHPT amid conservative or surgical management. In this narrative review, we searched PubMed (between January 2020 and July 2024) via different keywords. Fourteen studies from the final analysis (388 patients with NPHPT; 1188 with PHPT; and 803 controls) showed that mean serum calcium levels varied between 2.57 and 2.26 mmol/L in NPHPT. Ten studies identified a similar 24 h urinary calcium in NPHPT versus hypercalcemic PHPT (HPHPT). Except for one study, a mandatory vitamin D analysis was performed, but the 25-hydroxyvitamin D cut-offs varied. Osteoporosis (n = 6 studies; N = 172 with NPHPT) was confirmed in 41.7–100% of NPHPT subjects. In surgery candidates, this rate might be overestimated. A DXA analysis was performed in eight studies (235 subjects with NPHPT, and 455 patients with HPHPT); two studies identified a lower BMD in HPHPT < NPHPT, but the results were not homogenous. A single study analyzed the TBS and found similar results in NPHPT. The prevalence of fractures (n = 9) varied between 7.4% and 42.8% in NPHPT. Bone turnover markers (N = 262 patients, n = 8 studies) showed lower bone formation markers in NPHPT versus PHPT (n = 3). Two studies analyzed the BMD and bone turnover markers following parathyroidectomy (161 patients, including 30 patients with NPHPT; mean ages over 60 years). To conclude, given the wide spectrum of complications associated with PHPT, an early diagnosis and proper management is essential. A more extensive screening in patients with osteoporosis and kidney stones might lead to the discovery of NPHPT, a more recently described form of PHPT. While it is still unclear whether NPHPT is an early stage of HPHPT or a separate entity, recent findings show similar osteoporosis and fracture occurrence, and an improvement in bone metabolism, following parathyroidectomy. More extensive prospective studies are crucial to understand the natural course of the disease, to reach a consensus regarding parathyroidectomy indications and surgery candidates' selection, and to ensure proper personalized management for these patients. With the evolving diagnosis methods, PHPT has become a condition with a changing clinical presentation, which now requires modern evaluation and treatment approaches. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate comprehensive bone health among young Indian women, including bone mass, microarchitecture, and turnover, in relation to their non-alcoholic fatty liver disease (NAFLD) status. Methods: This cross-sectional study (May 2018–November 2019) recruited women with a history of gestational diabetes mellitus (GDM) and normoglycemia in their index pregnancy, who were at least 6 months postpartum. All participants underwent abdominal ultrasonography for determination of NAFLD status (grades 2 and 3: severe NAFLD) and transient elastography (FibroScan) for hepatic fibrosis (LSM >6 kPa). Bone mass was assessed by DXA, bone microarchitecture with trabecular bone score {TBS} (low TBS ≤ 1.310) and bone turnover with markers of bone formation (osteocalcin and P1NP), and resorption (CTX). Results: Bone mineral density (BMD) at femoral neck (p = 0.026) and total hip (p = 0.007) was significantly higher among women with NAFLD (n = 170) compared to those without (n = 124). There was no significant difference in bone turnover markers between the two groups. The presence of NAFLD [adjusted OR: 1.82 (1.07, 3.11)] was associated with low TBS, with a greater strength of association among women with severe NAFLD [adjusted OR: 2.97 (1.12, 7.88)]. However, these associations were attenuated and no longer significant after additionally adjusting for BMI. Women with NAFLD and hepatic fibrosis manifested significantly higher BMD at lumbar spine, femoral neck, and total hip (p < 0.001 for all) and significantly lower bone turnover markers (osteocalcin, p = 0.009 and CTX, p = 0.029), however, the association with low TBS was not observed. Conclusion: Among young Indian women, NAFLD is associated with increased bone mass and impaired bone microarchitecture, and hepatic fibrosis with increased bone mass and reduced bone turnover. [ABSTRACT FROM AUTHOR]

IntroductionDespite the high hopes for the use of transcranial magnetic stimulation (TMS) in the treatment of depression, between 30% and 60.5% of patients do not respond to stimulation. The factors contributing to non-response, especially those related to personality, remain insufficiently investigated. The main aim of our study was to compare the efficacy of active TMS and sham–placebo protocols in combined therapy of treatment-resistant depression with evaluation of possible personality disorders comorbidity.MethodsThe study was conducted between December 2019 and December 2022, as a randomized, double-blind, active comparator-controlled and sham-controlled parallel trial. Patients (n = 41) were randomized into one of two experimental conditions (active TMS vs. placebo) and screened before and after stimulation as well as at a 3-month follow-up. Personality disorders were assessed with The Structured Clinical Interview for DSM-5 Personality Disorders.ResultsThere were no significant differences between the TMS active and sham groups in terms of general characteristics, coexisting personality disorders, and Montgomery–Åsberg Depression Rating Scale scores before stimulation, at the end of stimulation, and after 3 months of stimulation. However, linear regression analysis revealed significant negative associations between the coexistence of personality disorders and the reduction of depressive symptoms from baseline to the end of stimulation. The post-hoc exploratory analysis on the first phase of the RCT confirmed the presence of personality disorders to be a consistent negative influence on the reduction of depressive symptoms post-stimulation, regardless of protocol and experimental condition and demonstrated a smaller percentage reduction in depressive symptoms after stimulation in patients with personality disorders.DiscussionA central conclusion, based on our study, is that transcranial magnetic stimulation for treatment-resistant depression cannot be considered as a method independent of co-occurring personality disorders.

Abstract Trabecular bone score (TBS) is a grayscale textural assessment resulting from a computed evaluation of pixel gray-level variations in previously obtained lumbar spine DXA images. It is an index of bone microarchitecture correlated with parameters of bone strength. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS can be used alongside Fracture Risk Assessment tool “FRAX” and bone mineral density (BMD) to enhance the assessment of fracture risk and to inform treatment initiation and monitoring. A systematic review was carried out aiming to update the evidence on the clinical use of the TBS in the management of both primary and secondary osteoporosis. Results revealed that in both primary and secondary osteoporosis, TBS enhances the prediction of fracture risk, and when adjust with BMD and clinical risk factors, it is able to inform the decision-making process regarding initiating osteoporosis therapy and the choice of anti-osteoporosis medication. Evidence also implies that TBS provides valuable adjunctive information in monitoring osteoporosis therapy. In conclusion, this work provides an up-to-date evidence-based review and recommendations which informs the utility of trabecular bone score in standard clinical practice.

Introduction: Trabecular bone score (TBS) estimates bone microstructure, which is directly measured by high-resolution peripheral quantitative computed tomography (HRpQCT). We evaluated the correlation between these methods and TBS influence on fracture risk assessed by FRAX. Materials and methods: We evaluated 129 individuals (82 women, 43 postmenopausal) 20 to 82.3 years without prevalent clinical or non-clinical morphometric vertebral fractures, using DXA (spine and hip), HR-pQCT at distal radius (R) and tibia (T) and TBS which classifies bone microarchitecture as normal (TBS ≥ 1.350), partially degraded (1.200 < TBS < 1.350), or degraded (TBS ≤ 1.200). Results: Spine and hip BMD and HR-pQCT parameters at cortical bone: area (T), density (R,T) thickness (T) and trabecular bone: density (R,T), number (T) and thickness (R) were significantly better in the 78 individuals with normal TBS (group 1) versus the 51 classified as partially degraded (n = 42) or degraded microarchitecture (n = 9) altogether (group 2). TBS values correlated with age (r = − 0.55), positively with spine and hip BMD and all cortical and trabecular bone density and microstructure parameters evaluated, p < 0.05 all tests. Binary logistic regression defined age (p = 0.008) and cortical thickness (p = 0.018) as main influences on TBS, while ANCOVA demonstrated that HR-pQCT data corrected for age were not different between TBS groups 1 and 2. TBS adjustment increased FRAX risk for major osteoporotic fractures and hip fractures. Conclusion: We describe significant association between TBS and both trabecular and cortical bone parameters measured by HR-pQCT, consistent with TBS influence on fracture risk estimation by FRAX, including hip fractures, where cortical bone predominates. [ABSTRACT FROM AUTHOR]

Simple Summary: This study analyzed the decomposition of cats, identified any unique decomposition characteristics, and determined the rate of decomposition using total body score (TBS) and accumulated degree days (ADDs). Determining the stages of decomposition is difficult because the stages do not have discrete beginnings and ends. Since there are so many different species of animals in the world that have very different characteristics, such as fur, size, and body fat, this adds another layer of difficulty to the stage of decomposition determination. Overall, there was not a significant difference between the rate of decomposition between light- and dark-furred cats. Unique decomposition characteristics were observed, such as fur obscuring details of decomposition, among others. Understanding these unique findings has considerable implications in future investigations involving the neglect and abuse of cats. Applying the findings would assist pathologists and veterinarians in their determination of neglect and abuse timeframes. Limited data about the differences between the decomposition of animals with fur exist within the forensic veterinary medicine discipline. Due to the sheer number of animals used as animal models and the number of animals that exist, determining stages of decomposition that are applicable for all species is difficult. Typically, assessing what stage of decomposition a decedent is in is subjective due to the visual assessment of decomposition changes. A method developed to rectify this issue was the total body score (TBS) method, which assigns a numerical value based on the degree of decomposition to the head, torso, and limbs. The purpose of this study was to examine the decomposition of cats, identify any unique decomposition characteristics, and determine the rate of decomposition using total body score and accumulated degree days (ADDs). Twelve domestic short-haired cats were placed in a grassy field in West Lafayette, IN. An assessment of TBS was documented for each cat and each experimental group. An exponential relationship between TBS and ADD was documented. Overall, there was not a significant difference in the rate of decomposition or total body scores between the groups (Z = −91.00, p = 0.0672). [ABSTRACT FROM AUTHOR]

Trabecular bone score (TBS) is a grayscale textural assessment resulting from a computed evaluation of pixel gray-level variations in previously obtained lumbar spine DXA images. It is an index of bone microarchitecture correlated with parameters of bone strength. Higher values of TBS indicate a better microarchitecture, whereas lower values indicate a degraded microarchitecture. TBS can be used alongside Fracture Risk Assessment tool "FRAX" and bone mineral density (BMD) to enhance the assessment of fracture risk and to inform treatment initiation and monitoring. A systematic review was carried out aiming to update the evidence on the clinical use of the TBS in the management of both primary and secondary osteoporosis. Results revealed that in both primary and secondary osteoporosis, TBS enhances the prediction of fracture risk, and when adjust with BMD and clinical risk factors, it is able to inform the decision-making process regarding initiating osteoporosis therapy and the choice of anti-osteoporosis medication. Evidence also implies that TBS provides valuable adjunctive information in monitoring osteoporosis therapy. In conclusion, this work provides an up-to-date evidence-based review and recommendations which informs the utility of trabecular bone score in standard clinical practice. [ABSTRACT FROM AUTHOR]

Theta burst stimulation (TBS) is a noninvasive brain stimulation technique that can be used to modulate neural networks underlying psychiatric and neurological disorders. TBS can be delivered intermittently or continuously. The conventional intermittent TBS protocol is approved by the U.S. Food and Drug Administration to treat otherwise treatment-resistant depression, but the 6-week duration limits the applicability of this therapy. Accelerated TBS protocols present an opportunity to deliver higher pulse doses in shorter periods of time, thus resulting in faster and potentially more clinically effective treatment. However, the acceleration of TBS delivery raises questions regarding the relative safety, efficacy, and durability compared with conventional TBS protocols. In this review paper, we present the data from accelerated TBS trials to date that support the safety and effectiveness of accelerated protocols while acknowledging the need for more durability data. We discuss the stimulation parameters that seem to be important for the efficacy of accelerated TBS protocols and possible avenues for further optimization. [ABSTRACT FROM AUTHOR]

Objective: Hyperglycemia promotes inflammation through inducing the formation of AGE products, which bind with receptor AGE (RAGE) products in cell membranes, leading to the activation of necrosis factor–kappa beta (NF-κB). This study aimed to analyze the effects of tempeh-based supplement (TBS) preparations of γ-amino butyric acid (GABA) tempeh against mRNA expressions of RAGE and NF-κB on the pancreas of a type 2 diabetes mellitus (DM) mice model. Material and Methods: This research was a quasi-experiment, with pre and post-tests with a control design for blood glucose levels; and post-test only utilizing control for mRNA RAGE and NF-κB expressions. A total of 30 male mice, 8-10 weeks old, weighing 20-25 g were divided into 6 treatment groups: non-diabetic, Diabetic, Diabetic+metformin, Diabetic+TBS 10 mg/100 g BW, Diabetic+TBS 20 mg/100 g BW, and Diabetic+TBS 40 mg/100 g BW. STZ induction once a day for two days was preceded by NA to create a DM mice model; meanwhile, TBS was administrated once a day for 21 days. Results: The mean difference of fasting glucose levels in the diabetic+TBS 40 mg/100 g BW group was the highest when compared to the diabetic group (159.52±1.85) mg/dL. One-way ANOVA revealed statistically significant differences in fasting glucose levels, RAGE and NF-κB expressions in the Diabetic+TBS group at various dosage levels compared to the diabetic control group. Relative mRNA expressions of RAGE and NF-κB were downregulated in the treatment group compared to the diabetic control group. Conclusion: TBS can decrease fasting blood glucose levels and downregulate relative mRNA expressions of RAGE and NF-κB in type 2 DM mice.

Diabetes, a disease marked by consistent high blood glucose levels, is associated with various complications such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. Notably, skeletal fragility has emerged as a significant complication in both type 1 (T1D) and type 2 (T2D) diabetic patients. This review examines noninvasive imaging studies that evaluate skeletal outcomes in adults with T1D and T2D, emphasizing distinct skeletal phenotypes linked with each condition and pinpointing gaps in understanding bone health in diabetes. Although traditional DXA-BMD does not fully capture the increased fracture risk in diabetes, recent techniques such as quantitative computed tomography, peripheral quantitative computed tomography, high-resolution quantitative computed tomography, and MRI provide insights into 3D bone density, microstructure, and strength. Notably, existing studies present heterogeneous results possibly due to variations in design, outcome measures, and potential misclassification between T1D and T2D. Thus, the true nature of diabetic skeletal fragility is yet to be fully understood. As T1D and T2D are diverse conditions with heterogeneous subtypes, future research should delve deeper into skeletal fragility by diabetic phenotypes and focus on longitudinal studies in larger, diverse cohorts to elucidate the complex influence of T1D and T2D on bone health and fracture outcomes. [ABSTRACT FROM AUTHOR]

CGL1 is a mannose-specific lectin isolated from the Pacific oyster Crassostrea gigas , and it belongs to the DM9 domain protein family. Each subunit of the CGL1 dimer consists of a tandem repeat of DM9 motifs, which were originally found in the Drosophila melanogaster genome. The CGL1 protomer contains two carbohydrate-binding sites: a high-affinity site A and a low-affinity site B. An assay using dendrimers containing oligomannose from yeast (Saccharomyces cerevisiae) revealed that CGL1 exhibited significantly higher affinity for mannotetraose (Man 4 ) compared to mannobiose (Man 2 ) and mannotriose (Man 3 ). To investigate its oligomannose-recognition mechanism, X-ray crystallographic analyses of CGL1/oligomannose complexes were performed. In the CGL1/Man 2 and CGL1/Man 3 complexes, Manα1–2Man and Manα1–2Manα1–2Man, respectively, were primarily bound to site A, interacting with the non-reducing mannose residue. On the other hand, in the CGL1/Man 4 crystal, Man 4 (Manα1–2Manα1–2Manα1–6Man) was bound at both site A and site B at the non-reducing and reducing ends, thus linking adjacent CGL1 molecules with crystallographic symmetry. These findings suggest that CGL1 can recognize both the non-reducing and reducing mannose residues of mannose oligosaccharides at its two distinct carbohydrate-binding sites. This enables efficient complex formation, making CGL1 a pattern-recognition molecule capable of recognizing diverse structures of mannose-containing carbohydrate chains. [ABSTRACT FROM AUTHOR]

Give cake – On reciprocity and resocialization in secure forensic unit: After collaborating with the author, Jan, the protagonist of a biography, commits a life crime. A 3.5-year sentence is followed by a more extended stay in a secure forensic unit (tbs). These settings are different. Jan is familiar with detention, and it is easy for him to move in this masculine world. However, in the forensic unit, he struggles as many adjustments are required. Over a period of 13 years, the relationship between Jan and the author changes. It reaches an equilibrium as gifts reciprocate, and this is a reflection of Jan's process of resocialization. [ABSTRACT FROM AUTHOR]

Copyright of Tijdschrift voor Herstelrecht is the property of Boom uitgevers Den Haag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bone fragility is a complication of type 2 diabetes mellitus (T2DM) that has been identified in recent decades. Trabecular bone score (TBS) appears to be more accurate than bone mineral density (BMD) in diabetic bone disease, particularly in menopausal women with T2DM, to independently capture the fracture risk. Our purpose was to provide the most recent overview on TBS-associated clinical data in T2DM. The core of this narrative review is based on original studies (PubMed-indexed journals, full-length, English articles). The sample-based analysis (n = 11, N = 4653) confirmed the use of TBS in T2DM particularly in females (females/males ratio of 1.9), with ages varying between 35 and 91 (mean 65.34) years. With concern to the study design, apart from the transversal studies, two others were prospective, while another two were case-control. These early-post-pandemic data included studies of various sample sizes, such as: males and females (N of 245, 361, 511, and 2294), only women (N of 80, 96, 104, 243, 493, and 887), and only men (N = 169). Overall, this 21-month study on published data confirmed the prior profile of BMD-TBS in T2DM, while the issue of whether checking the fracture risk is mandatory in adults with uncontrolled T2DM remains to be proven or whether, on the other hand, a reduced TBS might function as a surrogate marker of complicated/uncontrolled T2DM. The interventional approach with bisphosphonates for treating T2DM-associated osteoporosis remains a standard one (n = 2). One control study on 4 mg zoledronic acid showed after 1 year a statistically significant increase of lumbar BMD in both diabetic and non-diabetic groups (+3.6%, p = 0.01 and +6.2%, p = 0.01, respectively). Further studies will pinpoint additive benefits on glucose status of anti-osteoporotic drugs or will confirm if certain glucose-lowering regimes are supplementarily beneficial for fracture risk reduction. The novelty of this literature research: these insights showed once again that the patients with T2DM often have a lower TBS than those without diabetes or with normal glucose levels. Therefore, the decline in TBS may reflect an early stage of bone health impairment in T2DM. The novelty of the TBS as a handy, non-invasive method that proved to be an index of bone microarchitecture confirms its practicality as an easily applicable tool for assessing bone fragility in T2DM. [ABSTRACT FROM AUTHOR]

This study analyzed the differences in the decomposition patterns and post mortem intervals of hanged and surface carcasses using domestic pigs as human analogs. Six domestic pigs weighing between 25 kg and 30 kg were separated into two groups comprising three pigs each. Three pigs were hanged on the branches of trees at the research facility; whereas the other three pigs were placed on the soil surface. Daily periodic decomposition observations were noted and scored for a period of 30 days alongside the accumulated degree days. There is a statistically significant (P = 0.001) difference in the decomposition between hanged and surface pigs. The hanged pigs decomposed faster at the initial stage reaching a total body score (TBS) of 10 by the second day but gradually slowed down and mummified; whereas the surface pigs initially decomposed at a slower rate but later sped up at about 167 ADD till complete skeletonization. ADD and TBS are very reliable and accurate predictors for PMI estimation of surface and hanged pig carcasses. Insect colonization of a carcass is a very important factor that determines the rate of decomposition of hanged and surface pig carcasses in Okuku, Nigeria. There is a statistically significant difference in the decomposition rate and pattern of hanged and surface pig carcasses. The prediction models for estimating PMI considered ADD and TBS as variables, and these prediction models are very reliable at 95 % confidence level.

This study assessed the feasibility, implementation process and outcomes of the VReedom training; a virtual reality (VR)-based intervention designed to prepare forensic psychiatric patients for their first authorized leave. Clinical forensic mental healthcare organization Inforsa, operating at security level 3, introduced the VReedom training for forensic patients eligible for their first authorized leave, between March 1st and November 13th, 2022. Employing a retrospective observational cohort study design with patient dossier data as the primary source, the study also used participant observation, weekly evaluative questionnaires and focus group discussions as data sources. Five objectives were utilized to evaluate the feasibility: recruitment capacity and resulting sample characteristics, data collection and evaluation procedures, acceptability and suitability of the training and protocol, training management and implementation, and preliminary participant results. Despite the lack of a control group, findings align with literature suggesting VR's potential for enhancing treatment motivation and reducing stress in preparation for first authorized leave. Of 13 patients approached, 10 participated without dropouts, and no incidents occurred during training. Emotion elicitation was successful, supporting VR Exposure therapy's efficacy. Findings align with literature, emphasizing VR's value in forensic psychiatry. Establishing favorable implementation conditions was crucial, with positive reception from treatment providers. Also, the need for personalization and additional locations was identified, and the training seemed most suitable for patients with a tbsmeasure. Future research with control groups is recommended to further validate the effectiveness of the VReedom training intervention, and further protocol development is necessary to make it suitable for a broader population. Current findings contribute to the refinement and expansion of evidence-based practices in the field of VR-assisted training and treatment in forensic psychiatry. [ABSTRACT FROM AUTHOR]

Purpose: Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods: An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion: The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary: This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. [ABSTRACT FROM AUTHOR]

Familial partial lipodystrophies (FPLD) are rare diseases characterized by selective loss of subcutaneous adipose tissue at different sites. This cross-sectional observational study aimed to estimate adipose tissue in the bone marrow (BMAT), intra (IMCL) and extra-myocyte lipids (EMCL), and define the bone phenotype in the context of FPLD2/Dunnigan syndrome (DS). The subjects comprised 23 controls (C) and 18 DS patients, matched by age, weight and height. Blood samples, dual-energy X-ray absorptiometry for bone mineral density (BMD) and trabecular bone score (TBS) and 1H-spectroscopy using magnetic resonance to estimate BMAT in the lumbar spine, IMCL, EMCL and osteoclastogenesis were assessed. The prevalence of diabetes mellitus was 78% in DS patients. Glucose, HbA1c, triglycerides, insulin and HOMA-IR levels were elevated in DS, whereas HDLc, 25(OH)D, PTH and osteocalcin levels were reduced. BMD was similar between groups at all sites, except 1/3 radius, which was lower in DS group. TBS was reduced in DS. DS presented increased osteoclastogenesis and elevated BMAT, with greater saturation levels and higher IMCL than the C group. HOMA-IR and EMCL were negatively associated with TBS; osteocalcin and EMCL were correlated negatively with BMD. This study contributes to refining the estimation of adipose tissue in DS by showing increased adiposity in the lumbar spine and muscle tissue. DXA detected lower TBS and BMD in the 1/3 radius, suggesting impairment in bone quality and that bone mass is mainly affected in the cortical bone. [ABSTRACT FROM AUTHOR]

Copyright of Agribusiness Forum / Forum Agribisnis is the property of IPB University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Limited data about the differences between the decomposition of animals with fur exist within the forensic veterinary medicine discipline. Due to the sheer number of animals used as animal models and the number of animals that exist, determining stages of decomposition that are applicable for all species is difficult. Typically, assessing what stage of decomposition a decedent is in is subjective due to the visual assessment of decomposition changes. A method developed to rectify this issue was the total body score (TBS) method, which assigns a numerical value based on the degree of decomposition to the head, torso, and limbs. The purpose of this study was to examine the decomposition of cats, identify any unique decomposition characteristics, and determine the rate of decomposition using total body score and accumulated degree days (ADDs). Twelve domestic short-haired cats were placed in a grassy field in West Lafayette, IN. An assessment of TBS was documented for each cat and each experimental group. An exponential relationship between TBS and ADD was documented. Overall, there was not a significant difference in the rate of decomposition or total body scores between the groups (Z = −91.00, p = 0.0672).

ABSTRACT Growth hormone (GH) is nonphysiologically increased in acromegaly, stimulating target tissues directly and indirectly via insulin‐like growth factor type 1 (IGF‐1). Despite GH having anabolic effects on bone growth and renewal, the risk of vertebral fractures is paradoxically increased in acromegaly. We hypothesized that bone tissue compartments were differentially affected by hormonal alterations in active and controlled acromegaly. We aimed to study the effect of sex and gonadal status on long‐term outcome of bone mass and structure to understand the biomechanical competence of bone. We followed 62 patients with newly diagnosed acromegaly longitudinally (median 4.8 years after pituitary surgery) to investigate changes assessed by dual X‐ray absorptiometry (DXA), trabecular bone score (TBS), and hip structure analysis (HSA). At diagnosis, patients had increased bone mineral density (BMD) in most compartments compared with normative data (Z‐scores). Conversely, TBS Z‐score was decreased (Z = −0.64 (SD 1.73), p = 0.028). Following treatment of acromegaly, BMD increased further in compartments containing predominantly trabecular bone, such as the lumbar spine, in eugonadal and male subjects, while compartments with predominantly cortical bone, such as the hip and femoral neck, were unchanged. Total body measurements showed further increase in BMD independent of sex and gonadal status. TBS did not change. HSA revealed a significant decrease in cortical thickness in both sexes independent of gonadal status, whereas the overall size of bone (hip axis length and neck width) did not change over time. In conclusion, patients with acromegaly had increased bone mass and dimensions by DXA. Following normalization of disease activity, BMD increased mainly in compartments rich in trabecular bone, reflecting a closure of the remodeling space. However, HSA revealed a significant decrease in cortical thickness, implying endocortical trabecularization, potentially explaining the increased risk for incident vertebral fractures following treatment. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

This study assessed the feasibility, implementation process and outcomes of the VReedom training; a virtual reality (VR)-based intervention designed to prepare forensic psychiatric patients for their first authorized leave. Clinical forensic mental healthcare organization Inforsa, operating at security level 3, introduced the VReedom training for forensic patients eligible for their first authorized leave, between March 1st and November 13th, 2022. Employing a retrospective observational cohort study design with patient dossier data as the primary source, the study also used participant observation, weekly evaluative questionnaires and focus group discussions as data sources. Five objectives were utilized to evaluate the feasibility: recruitment capacity and resulting sample characteristics, data collection and evaluation procedures, acceptability and suitability of the training and protocol, training management and implementation, and preliminary participant results. Despite the lack of a control group, findings align with literature suggesting VR’s potential for enhancing treatment motivation and reducing stress in preparation for first authorized leave. Of 13 patients approached, 10 participated without dropouts, and no incidents occurred during training. Emotion elicitation was successful, supporting VR Exposure therapy’s efficacy. Findings align with literature, emphasizing VR’s value in forensic psychiatry. Establishing favorable implementation conditions was crucial, with positive reception from treatment providers. Also, the need for personalization and additional locations was identified, and the training seemed most suitable for patients with a tbs-measure. Future research with control groups is recommended to further validate the effectiveness of the VReedom training intervention, and further protocol development is necessary to make it suitable for a broader population. Current findings contribute to the refinement and expansion of evidence-based practices in the field of VR-assisted training and treatment in forensic psychiatry.

Our aim is to analyse the bone profile in adults with (non-functioning) adrenal incidentalomas (AIs), specifically addressing the impact of autonomous cortisol secretion (ACS). This narrative review, based on a PubMed search from inception to February 2023 (case reports, non-ACS, and other secondary causes of osteoporosis were excluded), included 40 original studies, a total of 3046 patients with female prevalence (female:male ratio of 1921:1125), aged between 20.5 and 95.5 years old. This three decade-based analysis showed that 37 studies provided dual-energy X-ray absorptiometry (DXA) information; another five studies reports results on bone micro-architecture, including trabecular bone score (TBS), spinal deformity index, and high-resolution peripheral quantitative computed tomography; 20 cohorts included data on bone turnover markers (BTMs), while four longitudinal studies followed subjects between 1 and 10.5 years old (surgical versus non-adrenalectomy arms). Post-dexamethasone suppression test (DST) cortisol was inversely associated with bone mineral density (BMD). TBS predicted incidental vertebral fractures (VFx) regardless of BMD, being associated with post-DST cortisol independently of age and BMD. Low BTMs were identified in ACS, but not all studies agreed. An increased prevalence of ACS-related osteoporosis was confirmed in most studies (highest prevalence of 87.5%), as well as of VFx, including in pre-menopause (42.5%), post-menopause (78.6%), and male patients (72.7%) depending on the study, with a 10-fold increased incidental VFx risk up to a 12-fold increased risk after a 2-year follow-up. No specific medication against osteoporosis is indicated in ACS, but adrenalectomy (according to four studies) should be part of the long-term strategy. This bone profile case sample-based study (to our knowledge, one of the largest of its kind) showed that AIs, including the subgroup designated as having ACS, embraces a large panel of osseous complications. The level of evidence remains far from generous; there are still no homogenous results defining ACS and identifying skeletal involvement, which might be a consequence of different investigation clusters underling adrenal and bone assessments over time. However, bone status evaluations and associated therapy decisions remain an essential element of the management of adults with AIs-ACS. [ABSTRACT FROM AUTHOR]

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ITER is an international collaborative effort towards the realization of fusion energy via the magnetic confinement concept. Two of the equatorial ports in the facility are dedicated to the testing of tritium breeding concepts, which is essential for the tritium self-sufficiency of future fusion reactors. The concerned Test Blanket System (TBS) consists of a Test Blanket Module (TBM) residing inside the TBM–Port Plug (TBM-PP) and its associated ancillary systems in the Tokamak facility. In this paper, the results of a full suite of nuclear analyses concerning the shielding performance of the Pipe Forest (PF) and Bioshield Plug (BP), to reflect on the evolution of their designs, are discussed. On the BP side, the design of the peripheral part has been reviewed considering the ventilation openings and butterfly doors, to assure the design compliance with the Radiation Map (RadMap) requirements for the neutron flux in the Port Cell (PC), behind the BP. On the PF side, the pipes routing and maintenance corridor door have been redesigned, by taking into account results from previously concluded nuclear analyses. The neutronics model was developed from CAD and was used to perform transport simulations in two plasma modes: on and off. For plasma-on mode, the plasma neutron field in the Port Interspace (PI) as well as behind the BP was assessed and few shielding options were explored. The responses due to decay neutrons from 17N in activated cooling water were also considered. For the plasma-off mode, the focus was shifted to further refine the ShutDown Dose Rate (SDDR) maps, which is of importance for maintenance operations that are foreseen to take place at various stages of ITER operation, in particular following the FPO-1, FPO-2, and Short operation scenarios. In addition, detailed activation analyses were carried out to provide a provisional waste classification.

Objetivo: Analizar la utilidad del trabecular bone score (TBS) en adultos con osteogénesis imperfecta (OI) y su relación con variables clínicas, antropométricas y densitométricas, especialmente con la presencia de fracturas y la severidad de la enfermedad. Material y métodos: Estudio transversal realizado en 31 pacientes adultos con OI (edad 40.5±15.2 años, 68% mujeres, 87% tipo I). Se analizaron las características clínicas de los pacientes (fracturas, tipo de OI, IMC y tratamiento), la densidad mineral ósea (DMO) (mediante DXA), valorando la presencia de osteoporosis densitométrica, y los valores de TBS (TBS iNsight), estimando la presencia de microarquitectura degradada (valores

• We evaluated the efficacy of intermittent theta-burst stimulation (iTBS) in postoperative care across two cortical targets. • iTBS reduced anaesthetic pump attempts. • This effect was unique to DLPFC stimulation while M1 had no effect. Repetitive transcranial magnetic stimulation (rTMS) may be a relevant method to assist postoperative pain. However, studies to date have only used conventional 10 Hz rTMS and targeted the DLPFC for postoperative pain. A more recent form of rTMS, termed intermittent Theta Burst Stimulation (iTBS), enables to increase cortical excitability in a short period of time. This preliminary double-blind, randomised, sham controlled study was designed to evaluate the efficacy of iTBS in postoperative care across two distinct stimulation targets. A group of 45 patients post laparoscopic surgery were randomised to receive a single session of iTBS over either the dorsolateral prefrontal cortex (DLPFC), primary motor cortex (M1), or Sham stimulation (1:1:1 ratio). Outcome measurements were number of pump attempts, total anaesthetic volume used, and self-rated pain experience, assessed at 1 hour, 6 hours, 24 hours, and 48 hours post stimulation. All randomised patients were analysed (n = 15 in each group). Compared to Sham stimulation, DLPFC-iTBS reduced pump attempts at 6 (DLPFC = 0.73 ± 0.88, Sham = 2.36 ± 1.65, P = 0.031), 24 (DLPFC = 1.40 ± 1.24, Sham = 5.03 ± 3.87, P = 0.008), and 48 (DLPFC = 1.47 ± 1.41, Sham = 5.87 ± 4.34, P = 0.014) hours post-surgery, whereby M1 stimulation had no effect. No group effect was observed on total anaesthetics, which was mainly provided through the continuous administration of opioids at a set speed for each group. There was also no group or interaction effect on pain ratings. Pump attempts were positively associated with pain ratings in the DLPFC (r = 0.59, P = 0.02) and M1 (r = 0.56, P = 0.03) stimulation. Our findings show that iTBS to the DLPFC reduces pump attempts for additional anaesthetics following a laparoscopic surgery. However, reduced pump attempts by DLPFC stimulation did not translate into a significantly smaller volume of total anaesthetic, due to the continuous administration of opioids at a set speed for each group. Our findings therefore provide preliminary evidence for iTBS targeting the DLPFC to be used to improve postoperative pain management. [ABSTRACT FROM AUTHOR]

ITER is an international collaborative effort towards the realization of fusion energy via the magnetic confinement concept. Two of the equatorial ports in the facility are dedicated to the testing of tritium breeding concepts, which is essential for the tritium self-sufficiency of future fusion reactors. The concerned Test Blanket System (TBS) consists of a Test Blanket Module (TBM) residing inside the TBM--Port Plug (TBM-PP) and its associated ancillary systems in the Tokamak facility. In this paper, the results of a full suite of nuclear analyses concerning the shielding performance of the Pipe Forest (PF) and Bioshield Plug (BP), to reflect on the evolution of their designs, are discussed. On the BP side, the design of the peripheral part has been reviewed considering the ventilation openings and butterfly doors, to assure the design compliance with the Radiation Map (RadMap) requirements for the neutron flux in the Port Cell (PC), behind the BP. On the PF side, the pipes routing and maintenance corridor door have been redesigned, by taking into account results from previously concluded nuclear analyses. The neutronics model was developed from CAD and was used to perform transport simulations in two plasma modes: on and off. For plasma-on mode, the plasma neutron field in the Port Interspace (PI) as well as behind the BP was assessed and few shielding options were explored. The responses due to decay neutrons from 17N in activated cooling water were also considered. For the plasma-off mode, the focus was shifted to further refine the ShutDown Dose Rate (SDDR) maps, which is of importance for maintenance operations that are foreseen to take place at various stages of ITER operation, in particular following the FPO-1, FPO-2, and Short operation scenarios. In addition, detailed activation analyses were carried out to provide a provisional waste classification. [ABSTRACT FROM AUTHOR]

Pneumonia is one of the most frequent diseases in foals between one and six months of age. Thereby Rhodococcus equi (R. equi) and Streptococcus equi subsp. zooepidemicus (Strep. zoo.) are regarded as the most common pathogens causing bacterial respiratory infections. The aim of the current study was to determine in which treatment group a faster reduction of fecal excretion of R. equi can be achieved during therapy. The study was designed as a prospective, randomized and blind study. 160 foals older than four weeks of age with moderate (abscess score 10–15cm) to severe (abscess score >15cm) pneumonia from a Warmblood stud were examined, randomly assigned to two treatment groups and initially treated for two weeks. Foals of group one (R/T), including 87 foals, were treated with rifampin, in a 10mg/ kg dose orally once daily, in combination with tulathromycin, in a 2.5mg/kg dose intramuscularly or intravenously once a week. According to the routine treatment of the foals on the study farm, there was a weekly rotation of IM and IV administration during the treatment. In the second group (R/A), 73 foals were treated with rifampin and azithromycin, both in a 10mg/kg dose orally once daily. All foals were subjected to a weekly weight control using a measuring tape from the start of therapy in order to ensure exact dosages. The success of the treatment was monitored once weekly based on the findings of the clinical examination and the sonographically determined pulmonary abscess score. Twenty-nine randomly chosen foals (R/T n=14; R/A n=15) of the two study groups were examined endoscopically on the day of diagnosis and tracheobronchial secretion (TBS) was sampled to identify the bacteria involved by culture. In addition, a native sample of the feces was obtained from each foal and a quantitative, culturally specific isolation and a polymerase chain reaction (PCR) for R. equi were performed. Samples from 29 foals were taken from July to September 2019. If R. equi was found in the feces, the foals were sampled once weekly with a rectal swab until the expected end of treatment (two weeks after the start of treatment) for R. equi PCR. In eight of the 14 foals (57,1%) from the R/T group and four of the 15 foals (26.6%) from the R/A group R. equi was identified in the tracheobronchial secretions and in the feces at the day of diagnosis. Other pathogens as Streptococcus equi subsp. equi, Bordetella bronchiseptica, Escherichia coli and Staphylococcus aureus were identified in the airway sample of very few foals of both treatment groups. Season seemed to influence the incidence of pathogens in sick foals. The exact test by Fisher showed that R. equi was detected significantly more frequently (P=0.0025) in the very warm and dry early summer months, while Strep. zoo. was isolated more frequently in late summer (P=0.0007). In the tracheobronchial secretions of foals with moderate to severe pneumonia, R. equi was detected significantly more frequently in high bacterial counts than in the feces (P<0.001). On the other hand, when a high number of R. equi was found in the feces, the number of that pathogen in the tracheobronchial secretions was also high. Our hypothesis, that R. equi is often isolated concurrently to Strep. zoo. detection was rejected with the two-sided test by Fisher (P=0,05). Two weeks after starting antimicrobial treatment, no foal showed positive pathogen detection in the feces anymore. Based on the results of the current study it can be assumed, that both active antimicrobial combinations are equally effective and that R. equi was eliminated in the gastrointestinal tract 14 days after starting treatment. [ABSTRACT FROM AUTHOR]

Abstract Background The World Health Organization (WHO) provides protocols for the diagnosis of malaria. One of them is related to the staining process of blood samples to guarantee the correct parasite visualization. Ensuring the quality of the staining procedure on thick blood smears (TBS) is a difficult task, especially in rural centres, where there are factors that can affect the smear quality (e.g. types of reagents employed, place of sample preparation, among others). This work presents an analysis of an image-based approach to evaluate the coloration quality of the staining process of TBS used for malaria diagnosis. Methods According to the WHO, there are different coloration quality descriptors of smears. Among those, the background colour is one of the best indicators of how well the staining process was conducted. An image database with 420 images (corresponding to 42 TBS samples) was created for analysing and testing image-based algorithms to detect the quality of the coloration of TBS. Background segmentation techniques were explored (based on RGB and HSV colour spaces) to separate the background and foreground (leukocytes, platelets, parasites) information. Then, different features (PCA, correlation, Histograms, variance) were explored as image criteria of coloration quality on the extracted background information; and evaluated according to their capability to classify images as with Good or Bad coloration quality from TBS. Results For background segmentation, a thresholding-based approach in the SV components of the HSV colour space was selected. It provided robustness separating the background information independently of its coloration quality. On the other hand, as image criteria of coloration quality, among the 19 feature vectors explored, the best one corresponds to the 15-bins histogram of the Hue component with classification rates of > 97%. Conclusions An analysis of an image-based approach to describe the coloration quality of TBS was presented. It was demonstrated that if a robust background segmentation is conducted, the histogram of the H component from the HSV colour space is the best feature vector to discriminate the coloration quality of the smears. These results are the baseline for automating the estimation of the coloration quality, which has not been studied before, but that can be crucial for automating TBS’s analysis for assisting malaria diagnosis process.

Background: Structural and metabolic disorders of bone tissue in women with T2DM have no clinical manifestations, but they are accompanied by the risk of fractures.Aim: To study the parameters of bone metabolism, BMD and microarchitectonics in female patients with T2DM in the Buryat population.Materials and methods: The observational single-center one-stage controlled study included 73 women with T2DM, which were divided into 2 groups depending on the functional state of the ovaries (reproductive and postmenopausal periods). In each group, subgroups of the Buryat and Russian populations were identified. The first group included 34 patients with T2DM of the reproductive period: 16 from the Buryat population and 18 from the Russian population. The second group consisted of 39 postmenopausal patients with T2DM: 17 from the Buryat population and 22 from the Russian population. The study of BMD in the lumbar spine (L1-L4), femoral neck (Neck), in the proximal femur (Total hip), trabecular bone score (TBS), serum osteocalcin (OC), N-terminal propeptide type 1 procollagen was carried out (P1NP), vitamin D 25 (OH), blood plasma type I collagen C-terminal telopeptide (β-Cross laps) and ionized calcium (iCa).Results: In female patients with T2DM of the reproductive age of the Buryat population, an increase in both markers of osteosynthesis P1NP (p=0.035), OC (p=0.047), and bone resorption β-Cross laps (p=0.040) was found relative to the similar group of the Russian population. In women with T2DM in the postmenopausal period of the Buryat population, there was also an increase in P1NP (p = 0.016), OC (p = 0.048), β-Cross laps (p = 0.020) compared with the group of postmenopausal women in the Russian population. Structural disorders, characterized by a decrease in TBS, were detected only in the postmenopausal period in female patients of the Buryat population compared to women in the Russian population (p = 0.029).Comparative analysis among women with T2DM of the Buryat population, depending on the functional state of the ovaries, showed that activation of bone remodeling with an increase in P1NP (p = 0.019), OC (p = 0.004) and β-Cross laps (p = 0.004) is characteristic of postmenopausal women accompanied by a decrease in BMD Neck (p = 0.006), BMD Total hip (p = 0.003), BMD L1-L4 (p = 0.049) and TBS (p = 0.020) relative to female patients with T2DM in the reproductive period.Conclusion: In women with T2DM in the Buryat population, both in the reproductive and postmenopausal periods, an increase in bone remodeling markers and BMD stability was found when compared with the corresponding groups of patients in the Russian population. The postmenopausal period was characterized by an additional decrease in TBS in patients with T2DM in the Buryat population relative to women in the Russian population.

Among older men, characteristics that predict longitudinal changes in trabecular bone score (TBS) are different from characteristics that predict changes in bone mineral density (BMD). Most notably, weight loss is strongly associated with concomitant loss in BMD but with concomitant increases in TBS, when measured on Hologic densitometers. INTRODUCTION:Our objective was to compare and contrast predictors of changes in TBS, total hip BMD, and lumbar spine BMD. METHODS:Our study population was 3969 Osteoporotic Fractures in Men (MrOS) cohort participants (mean age 72.8 years) with repeat measures of TBS, lumbar spine and total hip BMD, body mass index (BMI) less than 37 kg/m2, and no use of bisphosphonate or glucocorticoid medications. TBS was scored (Med-Imaps Software version 2.1) and BMD measured on Hologic densitometers. RESULTS:One thousand four hundred forty-four men had a TBS decrease > 0.04 units (estimated least significant change for TBS), 795 men had a TBS increase > 0.04 units, and 1730 men had TBS change ≤ 0.04 units over mean follow-up of 4.6 years. Older age was not associated with TBS change, but was associated with greater decline in lumbar spine and total hip BMD. Compared to stable weight, > 10% weight loss was strongly associated with an increase in TBS [effect size = 1.24 (95% CI 1.12, 1.36)] and strongly associated with a decrease in total hip BMD [- 1.16 (95% CI - 1.19, - 1.03)]. Other predictors discordant for longitudinal changes of TBS and BMD included baseline BMI, walk speed, and ACE inhibitor use. CONCLUSIONS:Predictors of changes in TBS are different from predictors of changes in lumbar spine and total hip BMD. At least when assessed on Hologic densitometers, weight loss is associated with subsequent declines in spine and total hip BMD but subsequent increase in TBS. Faster walk speed may protect against loss of hip BMD, but is not associated with longitudinal changes of TBS.

Scleroderma (systemic sclerosis) represents a challenging condition, usually requiring a multi-disciplinary team due to multi-organ involvement; it is mostly considered an autoimmune disease; the signature of the malady is the extensive fibrosis at the level of skin and multiple organs, associating endothelial/vessel damage and anomalies of immune response. We point out a few aspects concerning scleroderma-related osteoporosis. This is a literature review. Patients might associate low bone mineral density (the underling mechanisms are not entirely understood), thus an increased risk of fractures; so early recognition and treatment is mandatory for a better outcome. Some data showed that particularly vertebral fractures are prone to the condition. Almost half of individuals with the malady have osteoporosis (female prevalence, especially post-menopausal) and one third of them have an osteoporotic fracture. Older age and associated vitamin D deficiency increases the risk of fracture. Vitamin D has pleomorphic distribution, also targeting the immune modulation, cytokines puzzle, and the muscle-bone crosstalk in scleroderma. Hypovitaminosis D might be expected in these patients, while general D-supplementation has controversial benefits effects. Chronic inflammatory rheumatic conditions might benefit from the TBS use as fracture risk indicator through micro-architecture evaluation. It seems that patients with systemic sclerosis and malnutrition have lower TBS; high Dkk-1 serum levels (Dickkopf-1) is correlated with reduced TBS and advanced disease; TBS is correlated to the extent of microvascular complications; exposure to glucocorticoids (certain high-dose regimes) supplementary lowers TBS. Gastrointestinal complications are presented in 90% of patients with systemic sclerosis, involving fibrosis at any level which is a poor prognostic factor; malabsorption of nutrients and weight loss correlates with reduced bone formation while esophageal and gastric anomalies contraindicate the use of oral bisphosphonates for osteoporosis. Other abnormal elements of skeleton frame include: premature ovarian failure, serotonin system anomalies, chronic inflammation, potential side effects of immunosuppressant drugs. In patients with systemic sclerosis, the choices of medication targeting osteoporosis are limited; the use of intravenous bisphosphonates remains first line option (if renal function is adequate); the consideration of skin and esophageal anomalies is mandatory in the management of osteoporosis. Overall, the landscape of bone domain in systemic sclerosis is multi-leveled and some areas are still waiting for clear answers.

This research examined the effects that the variables of burial depth and presence of plastic wrapping had on the decomposition rate of fetal pig (Sus scrofa) remains in a New England environment. The decomposition of 56 fetal pigs was observed in four independent variable groups: 20 cm depth unwrapped, 20 cm wrapped, 60 cm unwrapped, and 60 cm wrapped, with exhumation at months 1, 2, 3, 6, 9, 12, and 18. The authors hypothesized that the rate of decay would be slower for wrapped remains and/or for remains at a greater burial depth. Analysis of these remains consisted of preburial and postburial mass, adipocere coverage, skeletal exposure, and decomposition quantified as Total Body Score (TBS). The difference between preburial and postburial mass was reported as a loss percentage to account for varying preburial masses. Wrapping was a significant influencer of mass loss percentage, with p = 0.0298 but not for the TBS, with p = 0.17565. Burial depth did not have a significant effect on either mass loss percentage or TBS, with p = 0.1956 and 0.08969, respectively. This study suggests that wrapping has a greater influence on decomposition patterns than burial depth in this environment, particularly the mass loss percentage. It is suggested that there are limitations with the use of TBS in Postmortem Interval (PMI) estimation, such as variable burial conditions and body characteristics. [ABSTRACT FROM AUTHOR]

Turner syndrome (TS), the most common type of X chromosomal disorder, has various, clinical manifestations. Among these, primary hypogonadism, which may lead to osteoporosis, is a life-long health issue. A high prevalence of fractures associated with osteoporosis is a major problem in patients with TS, where it may be 1.4-2.2 times higher than in healthy individuals and increases with age. Among the risk factors associated with fractures in TS, hypogonadism is arguably the most important. Estrogen deficiency due to hypogonadism leads to low bone mineral density (BMD), resulting in a high prevalence of bone fractures. Estrogen replacement therapy (ERT) in patients with TS reportedly improved their BMD. However, other causes of low BMD may exist, given that this condition begins in the prepubertal period in patients with TS. Most previous studies have reported low BMD in patients with TS using dualenergy X-ray absorptiometry (DXA), but this method has some limitations. Areal BMD values assessed by DXA were influenced by bone size and short stature, resulting in an underestimation of BMD. Currently, volumetric BMD values may be accurately obtained using peripheral quantitative computed tomography (pQCT). pQCT, high-resolution pQCT, and the trabecular bone score can also be used to evaluate bone quality, including bone geometry and microarchitecture, in TS. The present review discusses the high fracture risk, role of estrogen deficiency in low BMD, advantages and disadvantages of various bone assessment methods, and characteristics of bone quality in TS. [ABSTRACT FROM AUTHOR]

Objetivo: Analizar la utilidad del trabecular bone score (TBS) en adultos con osteogénesis imperfecta (OI) y su relación con variables clínicas, antropométricas y densitométricas, especialmente con la presencia de fracturas y la severidad de la enfermedad. Material y métodos: Estudio transversal realizado en 31 pacientes adultos con OI (edad 40.5±15.2 años, 68% mujeres, 87% tipo I). Se analizaron las características clínicas de los pacientes (fracturas, tipo de OI, IMC y tratamiento), la densidad mineral ósea (DMO) (mediante DXA), valorando la presencia de osteoporosis densitométrica, y los valores de TBS (TBS iNsight), estimando la presencia de microarquitectura degradada (valores <1.230). Los resultados se compararon entre los diferentes tipos de OI (I y III-IV) y con los de un grupo control de sujetos sanos. Resultados: La mayoría de los pacientes (29/31, 94%) tenían antecedentes de fracturas y el 29% recibía tratamiento antiosteoporótico. El 61% tenía una osteoporosis densitométrica y el 19% tenían una microarquitectura degradada. No se observaron diferencias en los valores del TBS según la gravedad de la OI (OI tipo I vs. III-IV: 1.297 vs. 1.339, p=n.s.); ningún paciente con OI tipo III-IV tenía TBS<1.230. Los valores de TBS se relacionaron con la edad (r=-0.6, p<0.01), la DMO lumbar (r=0.4, p=0.03) y el IMC (r=-0.5, p=0.01). Los pacientes con OI tenían valores más bajos de TBS y DMO que el grupo control en todas las localizaciones analizadas. Conclusión: El TBS es poco sensible en la valoración de la calidad ósea en la OI, pues ninguno de los pacientes con OI grave tenía una microarquitectura degradada y ésta sólo se observó en el 19% de los pacientes con OI a pesar de presentar una alta prevalencia de fracturas. [ABSTRACT FROM AUTHOR]

Objective: To analyze the usefulness of the trabecular bone score (TBS) in adults with osteogenesis imperfecta (OI) and its relationship with clinical, anthropometric and densitometric variables, especially with the presence of fractures and the severity of the disease. Material and methods: Cross-sectional study conducted in 31 adult patients with OI (age 40.5±15.2 years, 68% women, 87% type I). The clinical characteristics of the patients (fractures, type of OI, BMI and treatment), bone mineral density (BMD) (using DXA), assessing the presence of densitometric osteoporosis, and TBS values (TBS iNsight), estimating the presence of degraded microarchitecture (values <1.230). The results were compared between the different OI types (I and III-IV) and with those of a control group of healthy subjects. Results: Most of the patients (29/31, 94%) had a history of fractures and 29% received antiosteoporotic treatment. 61% had densitometric osteoporosis and 19% had degraded microarchitecture. No differences were observed in the TBS values according to OI severity (OI type I vs. III-IV: 1,297 vs. 1,339, p=n.s.); no patient with OI type III-IV had TBS <1230. TBS values were related to age (r=-0.6, p<0.01), lumbar BMD (r=0.4, p=0.03) and BMI (r=-0.5, p=0.01). Patients with OI had lower values of TBS and BMD than the control group in all locations analyzed. Conclusion: TBS is not very sensitive in assessing bone quality in OI, since none of the patients with severe OI had a degraded microarchitecture and this was only observed in 19% of patients with OI despite presenting a high prevalence of fractures. [ABSTRACT FROM AUTHOR]

Groundwater in Temeke and Ilala areas within Dar es Salaam city was analysed for physicochemical characteristics and heavy metal levels to assess its quality as potable water. Random sampling was used to obtain groundwater samples from three sampling sites, namely, residential areas, near petrol stations and dumping sites. Temperature, pH, and electrical conductivity (EC) were measured on-site by a water quality multimeter while heavy metals levels were determined by standard methods using Atomic Absorption Spectroscopy (AAS). Measurement of pH (pH 5.2-7.3) showed that groundwater largely satisfied TBS and WHO standards. Similarly, EC values of groundwater (256.5-5286 µScm-1) largely met TBS specifications while only 33% of groundwater complied with the WHO guidelines. Cd in groundwater from the three sampling sites (0.01-0.50 mgL-1) exceeded TBS and WHO standards. Pb in 89-94% of groundwater collected near petrol stations (0.01-1.10 mgL-1), 80% of groundwater from dumping site (0.01-1.22 mgL-1), and 25%-70% of groundwater from residential areas (0.01-0.65 mgL-1) exceeded the TBS and WHO standards. Cr concentration in 50-66% of groundwater samples collected near petrol stations (0.01-1.1 mgL-1) and 20-42% of groundwater from residential areas (0.01-0.45 mgL-1) exceeded TBS and WHO standards on total Cr. Levels of Cu (0.01-1.70 mgL-1) and Zn (0.01-1.82 mgL-1) were largely within the TBS and WHO standards. Groundwater in the study area is contaminated with nonpermissible levels of Cd, Pb and Cr, which makes it unsuitable for human consumption and hence likely to affect public health. [ABSTRACT FROM AUTHOR]

Theta burst stimulation (TBS) is a noninvasive brain stimulation technique that can modulate neural activity. The effect of TBS on regions beyond the motor cortex remains unclear. With increased interest in applying TBS to nonmotor regions for research and clinical purposes, these effects must be understood and characterized. We synthesized the electrophysiological effects of a single session of TBS, as indexed by electroencephalography (EEG) and concurrent transcranial magnetic stimulation and EEG, in nonclinical participants. We reviewed 79 studies that administered either continuous TBS or intermittent TBS protocols. Broadly, continuous TBS suppressed and intermittent TBS facilitated evoked response component amplitudes. Response to TBS as measured by spectral power and connectivity was much more variable. Variability increased in the presence of task stimuli. There was a large degree of heterogeneity in the research methodology across studies. Additionally, the effect of individual differences on TBS response has been insufficiently investigated. Future research investigating the effects of TBS as measured by EEG must consider methodological and individual factors that may affect TBS outcomes., (Copyright © 2024 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) at high frequency (HF) is an effective treatment of neuropathic pain. The classical HF-rTMS protocol (CHF-rTMS) includes a daily session for one week as an induction phase of treatment followed by more spaced sessions. Another type of protocol without an induction phase and based solely on spaced sessions of HF-rTMS (SHF-rTMS) has also been shown to produce neuropathic pain relief. However, CHF-rTMS and SHF-rTMS of M1 have never been compared regarding their analgesic potential. Another type of rTMS paradigm, called accelerated intermittent theta burst stimulation (ACC-iTBS), has recently been proposed for the treatment of depression, the other clinical condition for which HF-rTMS is proposed as an effective therapeutic strategy. ACC-iTBS combines a high number of pulses delivered in short sessions grouped into a few days of stimulation. This type of protocol has never been applied to M1 for the treatment of pain., Methods/design: The objective of this single-centre randomized study is to compare the efficacy of three different rTMS protocols for the treatment of chronic neuropathic pain: CHF-rTMS, SHF-rTMS, and ACC-iTBS. The CHF-rTMS will consists of 10 stimulation sessions, including 5 daily sessions of 10Hz-rTMS (3,000 pulses per session) over one week, then one session per week for 5 weeks, for a total of 30,000 pulses delivered in 10 stimulation days. The SHF-rTMS protocol will only include 4 sessions of 20Hz-rTMS (1,600 pulses per session), one every 15 days, for a total of 6,400 pulses delivered in 4 stimulation days. The ACC-iTBS protocol will comprise 5 sessions of iTBS (600 pulses per session) completed in half a day for 2 consecutive days, repeated 5 weeks later, for a total of 30,000 pulses delivered in 4 stimulation days. Thus, CHF-rTMS and ACC-iTBS protocols will share a higher total number of TMS pulses (30,000 pulses) compared to SHF-rTMS protocol (6,400 pulses), while CHF-rTMS protocol will include a higher number of stimulation days (10 days) compared to ACC-iTBS and SHF-rTMS protocols (4 days). In all protocols, the M1 target will be defined in the same way and stimulated at the same intensity using a navigated rTMS (nTMS) procedure. The evaluation will be based on clinical outcomes with various scales and questionnaires assessed every week, from two weeks before the 7-week period of therapeutic stimulation until 4 weeks after. Additionally, three sets of neurophysiological outcomes (resting-state electroencephalography (EEG), nTMS-EEG recordings, and short intracortical inhibition measurement with threshold tracking method) will be assessed the week before and after the 7-week period of therapeutic stimulation., Discussion: This study will make it possible to compare the analgesic efficacy of the CHF-rTMS and SHF-rTMS protocols and to appraise that of the ACC-iTBS protocol for the first time. This study will also make it possible to determine the respective influence of the total number of pulses and days of stimulation delivered to M1 on the extent of pain relief. Thus, if their analgesic efficacy is not inferior to that of CHF-rTMS, SHF-rTMS and especially the new ACC-iTBS protocol could be an optimal compromise of a more easy-to-perform rTMS protocol for the treatment of patients with chronic neuropathic pain., Competing Interests: Declaration of competing interest The authors declare that they have no commercial or financial relationships that could be understood as a potential conflict of interest in the present study. SC and MR are scientific advisors of Intrinsic Powers, spin off of the University of Milan., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)