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The presence of silicone particles in breast implant capsules has been observed since the 1970s. Since then, little data has been published regarding the amount of silicone that is susceptible to migrate into the capsule. Quantifying the amount of silicone migration from the implant to the capsule could inform on the level of silicone exposure a patient with breast implants may experience in the short- or long-term. The objective of this study is to present a histological quantification methodology of the number of silicone particles present in breast implant capsules.A prospective study was performed on capsule samples from patients requiring revision surgery. The slides were digitalized and analyzed with a viewer software. For each sample, we (1) manually counted each silicone particle, (2) measured the average particle size, (3) measured the capsule surface area, and (4) calculated the particle number density in each capsule sample. The average of all capsule samples' particle number densities was then compared to the total volume of the capsule to estimate the total number of silicone particles found within the capsule of each breast implant.Six capsules from six different patients were analyzed. Two capsules were from saline implants while four capsules were from silicone implants. All four silicone implant capsules contained between 352,928 and 9,002,235 silicone particles. The particle number density ranged from 20.5 to 683.5 particles per mmWe describe a new and reproducible methodology to quantify realistically the silicone particles in the periprosthetic capsule of breast implants.

Abdominoperineal resection (APR) of low rectal and anal tumors are performed for optimal oncological outcome but results in large defects in the perineum. Although vertical rectus abdominus (VRAM) flap is commonly employed for extensive perineal reconstruction, donor site morbidity remains problematic. The fascio-cutaneous "lotus petal" flap is an appealing option for reconstructing perineal defects as it may benefit from less donor site morbidity than other techniques. The purpose of this study is to demonstrate that the lotus flap should not only be limited to small and moderate sized defects, but can also be applied to extensive APR.A systematic review of the literature on the outcomes and dimensions of the lotus flap was performed. Articles with clear anatomical landmarks and internal pudendal artery flaps dimensions were identified. Afterwards, the lotus flap technique was applied on a series of patients with extensive perineal defects following APR treated in our center.Four articles on internal pudendal artery perforator flap were selected. The average reported size of this flap was 13cm×6cm. In our center, reconstruction of the perineum with oversized lotus flaps was performed on 10 consecutive patients. None had partial/complete flap loss or donor-site morbidity. The use of a Jack-Knife surgical position, indocyanide green fluorescence imaging, and preservation of a proximal skin bridge can extend the size of a secure flap to up to 20cm in length.The oversized lotus flap is a reliable option for reconstruction after extensive APR.

X-linked hypophosphataemia (XLH) is the most frequent cause of hypophosphataemia-associated rickets of genetic origin and is associated with high levels of the phosphaturic hormone fibroblast growth factor 23 (FGF23). In addition to rickets and osteomalacia, patients with XLH have a heavy disease burden with enthesopathies, osteoarthritis, pseudofractures and dental complications, all of which contribute to reduced quality of life. This Consensus Statement presents the outcomes of a working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, and provides robust clinical evidence on management in XLH, with an emphasis on patients’ experiences and needs. During growth, conventional treatment with phosphate supplements and active vitamin D metabolites (such as calcitriol) improves growth, ameliorates leg deformities and dental manifestations, and reduces pain. The continuation of conventional treatment in symptom-free adults is still debated. A novel therapeutic approach is the monoclonal anti-FGF23 antibody burosumab. Although promising, further studies are required to clarify its long-term efficacy, particularly in adults. Given the diversity of symptoms and complications, an interdisciplinary approach to management is of paramount importance. The focus of treatment should be not only on the physical manifestations and challenges associated with XLH and other FGF23-mediated hypophosphataemia syndromes, but also on the major psychological and social impact of the disease.

Plagiarism and self-plagiarism are widespread in biomedical publications, although journals are increasingly implementing plagiarism detection software as part of their editorial processes. Wikipedia, a free online encyclopedia written by its users, has global public health importance as a source of online health information. However, plagiarism of Wikipedia in peer-reviewed publications has received little attention. Here, I present five cases of PubMed-indexed articles containing Wiki-plagiarism, i.e. copying of Wikipedia content into medical publications without proper citation of the source. The true incidence of this phenomenon remains unknown and requires systematic study. The potential scope and implications of Wiki-plagiarism are discussed.

Resumen Los humedales costeros son ecosistemas que cada día se reducen más debido a factores antrópicos. Los estudios taxonómicos y ecológicos de estos ambientes son escasos, en especial en el Neotrópico. La falta de monitoreos biológicos en estas zonas impide evidenciar la probable pérdida de biodiversidad acuática. El presente estudio tuvo como objetivo elaborar los primeros listados taxonómicos de larvas de dípteros acuáticos de dos humedales de la costa central de Perú, así como describir la crianza de pupas y emergencia de adultos de Ephydridae (Diptera) en el laboratorio. Las estaciones de muestreo con presencia de pupas de efídridos se caracterizaron por presentar aguas rasas con sustrato fangoso y vegetación emergente de porte bajo; solo las pupas de Ephydra gracilis se encontraron en pozas poco profundas y sin vegetación, flotando o incrustadas en costras de sal. El éxito de la crianza de efídridos fue del 53 %, donde el desarrollo de hongos y la aparición de himenópteros parasitoides redujo dicho porcentaje en algunos de los géneros. El éxito de los adultos emergidos de E. gracilis fue menor que el de los demás, probablemente por la ausencia de alguna condición fisicoquímica que solo encuentran en su hábitat natural. Se brinda aquí un primer listado taxonómico de dípteros acuáticos y parasitoides en estos dos humedales costeros, el primer registro de Ephydra gracilis (Packard, 1871) en Suramérica e ilustraciones de las pupas como apoyo para su identificación. Además, se presentan recomendaciones para la recolección y el cuidado de dípteros en estadios tempranos en el laboratorio. Abstract Coastal wetlands are ecosystems that are being reduced every day due to anthropic factors. In these environments, taxonomic and ecological studies are scarce, especially in the Neotropical zone. The lack of biological monitoring in these areas has prevented the gathering of evidence on a probable loss of aquatic biodiversity. In the present study, we present the first taxonomic list of aquatic Diptera larvae from two wetlands of the central coast of Perú. Additionally, we describe the breeding of pupae and the emergence of Ephydridae (Diptera) adults in the laboratory. The sites with the presence of Ephydridae pupae were characterized by shallow waters with a muddy substrate and low vegetation; only Ephydra gracilis pupae were found in shallow pools with no vegetation, floating or embedded in salt crusts. The success of ephedrid flies breeding was 53% as the development of fungi and the emergence of parasitoid Hymenoptera reduced the emergence success of some of the genera. Adult emergence success from Ephydra gracilis was lower than that of others, probably due to the lack of some physicochemical condition only found in its natural habitat. We present a first taxonomic listing of aquatic Diptera for two coastal wetlands, the first record of Ephydra gracilis (Packard, 1871) in South America, and illustrations of the pupae supporting its identification. We also give recommendations for the collection and care of early stages of Diptera flies in the laboratory.

Supplemental Digital Content is available in the text., OBJECTIVES: Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019. DATA SOURCES: We contacted the corresponding authors of 16 eligible studies published between December 1, 2019, and February 28, 2021, reporting on patients with confirmed coronavirus disease 2019 admitted to ICU with a documented Clinical Frailty Scale. STUDY SELECTION: Individual patient data were obtained from seven studies with documented Clinical Frailty Scale were included. We classified patients as nonfrail (Clinical Frailty Scale = 1–4) or frail (Clinical Frailty Scale = 5–8). DATA EXTRACTION: We collected patient demographics, Clinical Frailty Scale score, ICU organ supports, and clinically relevant outcomes (ICU and hospital mortality, ICU and hospital length of stays, and discharge destination). The primary outcome was hospital mortality. DATA SYNTHESIS: Of the 2,001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and Sequential Organ Failure Assessment score, Clinical Frailty Scale score greater than or equal to 4, use of mechanical ventilation, vasopressors, renal replacement therapy, and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in patients with frailty (65.2% vs 41.8%; p < 0.001), with adjusted mortality increasing with a rising Clinical Frailty Scale score beyond 3. Younger and nonfrail patients were more likely to receive mechanical ventilation. Patients with frailty spent less time on mechanical ventilation (median days [interquartile range], 9 [5–16] vs 11 d [6–18 d]; p = 0.012) and accounted for only 12.3% of total ICU bed days. CONCLUSIONS: Patients with frailty with coronavirus disease 2019 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with nonfrail patients. Patients with frailty receiving mechanical ventilation were at greater risk of death than patients without frailty.

Background Ventilation has emerged as an important strategy to reduce indoor aerosol transmission of coronavirus disease 2019. Indoor air carbon dioxide (CO2) concentrations are a surrogate measure of respiratory pathogen transmission risk. Objectives To determine whether CO2 monitors are necessary and effective to improve ventilation in hospitals. Methods A randomized, placebo (sham)-controlled, crossover, open label trial. Between February and May 2021, we placed CO2 monitors in twelve double-bed patient rooms across two geriatric wards. Staff were instructed to open windows, increase the air exchange rate and reduce room crowding to maintain indoor air CO2 concentrations ≤800 parts per million (ppm). Results CO2 levels increased during morning care and especially in rooms housing couples (rooming-in). The median (interquartile range, IQR) time/day with CO2 concentration > 800 ppm (primary outcome) was 110 min (IQR 47–207) at baseline, 82 min (IQR 12–226.5) during sham periods, 78 min (IQR 20–154) during intervention periods and 140 min (IQR 19.5–612.5) post-intervention. The intervention period only differed significantly from the post-intervention period (P = 0.02), mainly due to an imbalance in rooming-in. Significant but small differences were observed in secondary outcomes of time/day with CO2 concentrations > 1000 ppm and daily peak CO2 concentrations during the intervention vs. baseline and vs. the post-intervention period, but not vs. sham. Staff reported cold discomfort for patients as the main barrier towards increasing ventilation. Discussion Indoor air CO2 concentrations in hospital rooms commonly peaked above recommended levels, especially during morning care and rooming-in. There are many possible barriers towards implementing CO2 monitors to improve ventilation in a real-world hospital setting. A paradigm shift in hospital infection control towards adequate ventilation is warranted. Trial registration ClinicalTrials.gov Identifier: NCT04770597, Graphical abstract Unlabelled Image

Orthogeriatrics is increasingly recommended in the care of hip fracture patients, although evidence for this model is conflicting or at least limited. Furthermore, there is no conclusive evidence on which model [geriatric medicine consultant service (GCS), geriatric medical ward with orthopedic surgeon consultant service (GW), integrated care model (ICM)] is superior. The review summarizes the effect of orthogeriatric care for hip fracture patients on length of stay (LOS), time to surgery (TTS), in-hospital mortality, 1-year mortality, 30-day readmission rate, functional outcome, complication rate, and cost. Two independent reviewers retrieved randomized controlled trials, controlled observational studies, and pre/post analyses. Random-effects meta-analysis was performed. Thirty-seven studies were included, totaling 37.294 patients. Orthogeriatric care significantly reduced LOS [mean difference (MD) - 1.55 days, 95% confidence interval (CI) (- 2.53; - 0.57)], but heterogeneity warrants caution in interpreting this finding. Orthogeriatrics also resulted in a 28% lower risk of in-hospital mortality [95%CI (0.56; 0.92)], a 14% lower risk of 1-year mortality [95%CI (0.76; 0.97)], and a 19% lower risk of delirium [95%CI (0.71; 0.92)]. No significant effect was observed on TTS and 30-day readmission rate. No consistent effect was found on functional outcome. Numerically lower numbers of complications were observed in orthogeriatric care, yet some complications occurred more frequently in GW and ICM. Limited data suggest orthogeriatrics is cost-effective. There is moderate quality evidence that orthogeriatrics reduces LOS, in-hospital mortality, 1-year mortality, and delirium of hip fracture patients and may reduce complications and cost, while the effect on functional outcome is inconsistent. There is currently insufficient evidence to recommend one or the other type of orthogeriatric care model. ispartof: Calcified Tissue International vol:110 issue:2 pages:162-184 ispartof: location:United States status: Published online

Purpose: Frailty is often used in clinical decision-making for patients with COVID-19, yet studies have found variable influence of frailty on outcomes in those admitted to the intensive care unit (ICU). In this individual patient data meta-analysis, we evaluated the characteristics, and outcomes of frail patients admitted to ICU with COVID-19.Methods: We contacted the corresponding authors of sixteen eligible studies published between December 1st 2019 and February 28th 2021 reporting the clinical frailty scale (CFS) in patients with confirmed COVID-19 admitted to ICU. Individual patient data was obtained from 7 studies. We classified patients as non-frail (CFS=1-4) or frail (CFS=5-8). The primary outcome was hospital mortality. We also compared the use of mechanical ventilation (MV) and the proportion of ICU bed-days between frailty categories. Results: Of the 2001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and sequential organ failure assessment (SOFA) score, CFS ≥4, use of MV, vasopressors, renal replacement therapy and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in frail patients (65.2% vs. 41.8%; pConclusion: Frail patients with COVID-19 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with non-frail patients. Frail patients receiving MV were at greater risk of death than non-frail patients. Systematic review registration: Registration protocol in PROSPERO (CRD42020224255).

Resume Introduction L’objectif de cette etude est d’analyser la satisfaction des patients apres une lipoaspiration abdominale sculptante seule ou associee a une abdominoplastie. Materiel et methodes Tous les dossiers des patients ayant beneficie d’une lipoaspiration abdominale sculptante entre 2016 et 2017 ont ete analyses. Les patients eligibles ont alors ete contactes par telephone et soumis a un questionnaire de satisfaction elabore par nos soins. Les patients ont alors ete repartis en 3 groupes en fonction de l’indication operatoire : lipoaspiration abdominale sculptante pure, lipoaspiration abdominale pour lipomodelage mammaire et lipoaspiration en association avec une abdominoplastie. Resultats Vingt-deux patients sur 30 ont accepte de repondre au questionnaire : 6 dans le groupe lipoaspiration abdominale sculptante, 9 dans le groupe limodelage mammaire et 7 dans le groupe abdominoplastie. Pour 41 % des patients, le resultat etait tout a fait conforme a leurs attentes. Il etait plutot conforme dans 50 % des cas et non conforme dans 9 % des cas. Cinquante pour cent des patients etaient totalement satisfaits de la stabilite du resultat dans le temps et 45 % plutot satisfaits, soit une satisfaction moyenne de 95 %. Quatorze pour cent des patients ont estime leur resultat excellent, 41 % tres bon, 32 % bon et 14 % moyen. Aucun patient n’a juge son resultat mediocre. Pour 96 % des patients, le choix de l’intervention etait une bonne voire une tres bonne decision et 77 % le referaient sans hesiter. Conclusion La lipoaspiration abdominale sculptante apporte une satisfaction globale des patients elevee. Elle a un impact positif sur la vie du patient, avec un risque de complications faible.

Androgens via the androgen receptor (AR) are required for optimal male bone health. The target cell(s) for the effects of androgens on cortical bone remain(s) incompletely understood. In females, estrogen receptor alpha in neurons is a negative regulator of cortical and trabecular bone. Whether neuronal AR regulates bone mass in males remains unexplored. Here, we inactivated AR in neurons using a tamoxifen-inducible CreERT2 under the control of the neuronal promoter Thy1. Tamoxifen induced a 70% to 80% reduction of AR mRNA levels in Thy1-CreERT2-positive brain regions cerebral cortex and brainstem as well as in the peripheral nervous tissue of male neuronal AR knockout (N-ARKO) mice. Hypothalamic AR mRNA levels were only marginally reduced and the hypothalamic-pituitary-gonadal axis remained unaffected, as determined by normal levels of serum testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). In contrast to orchidectomy, deletion of neuronal AR did not alter body weight, body composition, hindlimb muscle mass, grip strength, or wheel running. MicroCT analysis of the femur revealed no changes in bone accrual during growth in N-ARKO mice. However, 36- and 46-week-old N-ARKO mice displayed an accelerated age-related cortical involution, namely a more pronounced loss of cortical thickness and strength, which occurred in the setting of androgen sufficiency. Neuronal AR inactivation decreased the cancellous bone volume fraction in L5 vertebra but not in the appendicular skeleton of aging mice. MicroCT findings were corroborated in the tibia and after normalization of hormonal levels. Serum markers of bone turnover and histomorphometry parameters were comparable between genotypes, except for a 30% increase in osteoclast surface in the trabecular compartment of 36-week-old N-ARKO mice. Cortical bone loss in N-ARKO mice was associated with an upregulation of Ucp1 expression in brown adipose tissue, a widely used readout for sympathetic tone. We conclude that androgens preserve cortical integrity in aging male mice via AR in neurons. © 2018 American Society for Bone and Mineral Research. ispartof: JOURNAL OF BONE AND MINERAL RESEARCH vol:34 issue:3 pages:508-519 ispartof: location:United States status: published

Coronavirus disease 2019 (COVID-19) has caused considerably morbidity and mortality worldwide, mainly among older adults. Hospital outbreaks contribute to the burden of this disease, despite optimal hand hygiene and personal protective equipment such as masks and face shields. Ventilation with fresh outdoor air has emerged as an important strategy to reduce indoor aerosol transmission of COVID-19. Carbon dioxide (CO2) monitors are increasingly advocated to facilitate ventilation in schools, long-term care facilities, offices and public buildings. Moreover, several health authorities have issued guidelines for target CO2 values in work as well as clinical environments. Given that modern hospitals have superior indoor air quality control systems, it remains however unknown whether feedback from CO2 monitors is needed and/or effective to improve ventilation further. Here, we describe the rationale and protocol for a randomized, sham-controlled, crossover, open label trial of CO2 monitors in double-bed hospital rooms in two acute geriatric wards. Based on pilot data, Aranet4 Home® monitors will be used to alert nurses and other staff to raised indoor CO2 concentrations. Practical limitations in implementing CO2 monitors are discussed, and will be surveyed among staff as additional study outcomes. The Monitors to Improve Indoor Carbon Dioxide (CO2) Concentrations in the Hospital (MICH) trial is registered at ClinicalTrials.gov, identifier: NCT04770597 .

Introduction Fractures of the pelvis and acetabulum are associated with osteoporosis, and their incidence is rising in older adults. In the last decade an increasing number of these fractures are being operated in older patients in certain regions. The goal of this study was to describe the incidence of pelvic and acetabular fractures in Belgium between 1988 and 2018. Materials & methods This retrospective, nationwide, population-based study was conducted with the help of the national health insurance database from the Belgian National Institute for Health and Disability Insurance (NIHDI-RIZIV-INAMI). Multiple codes for the reimbursement of the diagnosis and treatment of pelvic and acetabular fractures were collated and (since 2006) linked to the patients' age group, sex and region. Results Between 1988 and 2018, 91.317 pelvic and acetabular fractures were diagnosed. The overall incidence increased from 15,8/100.000 persons per year in 1988 to 29,7/100.000 persons per year in 2006 and to 37,6/100.000 persons per year in 2018. These fractures showed a bimodal incidence, with a small peak in children (particularly boys), and an increasing incidence in older adults, particularly in women. Between 2006 and 2018, 5.957 (12,4%) patients underwent surgical treatment for their pelvic fracture. 2.088 patients underwent an osteosynthesis of the acetabulum and 3869 patients underwent an osteosynthesis of the pelvic ring. There were 3622 osteosynthesises (60.8%) in patients younger than 60 years old and 2335 (39,1%) in patients over 60 years old. Conclusion There is an increasing incidence of pelvic and acetabular fractures in Belgium with the majority of these fractures occurring in older people. Younger adults have the highest proportion of surgical treatment, but given the much higher incidence in older adults, there is a considerable amount of operations in older adults too.

Purpose To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients. Materials and Methods This was a HIPAA-compliant, institutional review board-approved retrospective study. From March 15 to June 1, 2020, 250 RT-PCR confirmed COVID-19 patients were studied with low-dose chest CT at admission. Visual and AI-assisted analysis of lung involvement was performed by using a semi-quantitative CT score and a quantitative percentage of lung involvement. Adverse outcome was defined as intensive care unit (ICU) admission or death. Cox regression analysis, Kaplan-Meier curves, and cross-validated receiver operating characteristic curve with area under the curve (AUROC) analysis was performed to compare model performance. Intraclass correlation coefficients (ICCs) and Bland- Altman analysis was used to assess intra- and interreader reproducibility. Results Adverse outcome occurred in 39 patients (11 deaths, 28 ICU admissions). AUC values from AI-assisted analysis were significantly higher than those from visual analysis for both semi-quantitative CT scores and percentages of lung involvement (all P

Male gender is a protective factor against the development of osteoporosis but men face a higher refracture risk, higher mortality risk, and a higher treatment gap. Consequently, men contribute considerably to the disease burden of osteoporosis. This chapter aims to review recent advances in our understanding of the epidemiology of male osteoporosis, the reasons why osteoporosis and fractures are less common in men, how sex steroids (androgens and estrogens) and other factors regulate male bone metabolism and contribute to skeletal sexual dimorphism, as well as the diagnosis and treatment of male osteoporosis. We focus on similarities and differences in men versus women. Our work aims to contribute to the understanding of male osteoporosis as a condition that is much more similar than different from osteoporosis in postmenopausal women.

The proximal interphalangeal (PIP) joint is particularly vulnerable to trauma. In comminuted fractures, arthroplasty with a silicone implant is a treatment option that may be controversial in an emergency setting. This joint destruction is usually accompanied by soft tissue injuries (skin and tendon damage, devascularization) making the reconstruction all the more complex. The aim of our work was to evaluate emergency finger silicone implants for complex and comminuted fractures of the PIP joint as well as clinical and radiological complications. In this single-center, retrospective study, 13 patients operated between January 2007 and January 2019 on an emergency basis with a Neuflex® PIP arthroplasty were reviewed. This PIP joint reconstruction was associated with the soft tissue repair at the same time (skin cover, tendons, nerves) in all patients. The average age was 57.7 years with a male predominance (92%). The injuries were caused by a domestic accident in 61% of cases. The average follow-up was 4.7 years. The average total active motion arc was 183.8°. The average QuickDASH score was 24. There was one case of broken implant with no functional consequence. No infection or instability was reported. Silicone implant arthroplasty is a simple, reliable, fast, and durable solution for complex PIP fractures when conservative treatment is impossible. This solution is an alternative to arthrodesis or even finger amputation.

A 63-year-old woman presented to the outpatient metabolic bone disease clinic with a 6-month history of lumbar and dorsal back pain. Initially, facet arthrosis was suspected and physical therapy suggested. See related editorial, page [339][1] Physical therapy for 1 month brought no improvement in

This systematic review and meta-analysis found low-quality evidence that orthogeriatric care is positively associated with diagnosis of osteoporosis, prescription of calcium and vitamin D supplements and bisphosphonates in older hip fracture patients. Evidence on fall and fracture prevention was scarce and inconclusive. Orthogeriatrics may reduce the treatment gap following hip fractures. Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear. To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures. Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914). One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85 years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26–17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07–242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87–17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other. Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear.

The skeletal effects of renal transplantation are not completely understood, especially in patients managed with a steroid minimization immunosuppressive protocol and long term. We enrolled 69 adult transplant recipients (39 males; ages 51.1 ± 12.2 years), free of antiresorptive therapy and managed with a steroid minimization immunosuppressive protocol, into a 5-year prospective observational study to evaluate changes in areal bone mineral density (aBMD), mineral metabolism and bone remodelling. Dual energy X-ray absorptiometry, laboratory parameters of mineral metabolism (including parathyroid hormone, sclerostin and fibroblast growth factor 23) and non-renal cleared bone turnover markers (BTMs) (bone-specific alkaline phosphatase, trimeric N-terminal propeptide and tartrate-resistant acid phosphatase 5b) were assessed at baseline and 1 and 5 years post-transplantation. The mean cumulative methylprednisolone exposure at 1 and 5 years amounted to 2.5 ± 0.8 and 5.8 ± 3.3 g, respectively. Overall, bone remodelling activity decreased after transplantation. Post-transplant aBMD changes were minimal and were significant only in the ultradistal radius during the first post-operative year {median -2.2% [interquartile range (IQR) -5.9-1.2] decline, P = 0.01} and in the lumbar spine between Years 1 and 5 [median 1.6% (IQR -3.2-7.0) increase, P = 0.009]. BTMs, as opposed to mineral metabolism parameters and cumulative corticosteroid exposure, associated with aBMD changes, both in the early and late post-transplant period. Most notably, aBMD changes inversely associated with bone remodelling changes. In summary, in de novo renal transplant recipients treated with a steroid minimization immunosuppressive protocol, BMD changes are limited, highly variable and related to remodelling activity rather than corticosteroid exposure. ispartof: Nephrol Dial Transplant vol:35 issue:4 pages:697-705 ispartof: location:England status: published

Bisphenol A (BPA) and Diethylhexyl Phthalate (DEHP) are well-studied endocrine disrupting chemicals (EDCs), however, the effects of mixtures of these EDCs are not. To assess the consequences of prenatal exposure to a mixture of these EDCs, dams were orally administered either saline (control), BPA (5 μg/kg BW/day), high dose DEHP (HD-D; 7.5 mg/kg BW/day), or a combination of BPA with HD-D in experiment 1; saline, BPA (5 μg/kg BW/day), low-dose DEHP (LD-D; 5 μg/kg BW/day) or a combination of BPA with LD-D in experiment 2. Gestational weights, number of abortions, litter size and weights, number of live births and stillbirths were recorded. Morphometric measures were obtained at birth and body weight, food and water intake were monitored weekly from postnatal weeks 3–12. Offspring were sacrificed at 16–24 weeks of age and organ weights were measured. The abortion rate of dams exposed to HD-D and the mixtures, BPA + LD-D and BPA + HD-D were higher at 9, 14 and 27% respectively. Prenatal exposure to BPA or HD-D significantly decreased relative thymus weights in male but not female offspring. Apoptotic cells were detected in thymus sections of both male and female offspring prenatally exposed to DEHP. Relative heart weights increased in BPA + HD-D exposed male offspring compared to the other groups. The results indicate that a mixture of BPA and DEHP, produced a pronounced effect on pregnancy outcomes. Male offspring appear to be more susceptible to the programming effects of these EDCs or their mixture suggesting a need to reconsider the possible additive, antagonistic or synergistic effects of EDC mixtures.

ispartof: Joint Bone Spine vol:87 issue:2 pages:171-173 ispartof: location:France status: published

This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone., SCOPUS: re.j, info:eu-repo/semantics/published

Purpose: To provide updated evidence-based guidelines for the management of osteoporosis in postmenopausal women in Belgium. Methods: The Belgian Bone Club (BBC) gathered a guideline developer group. Nine “Population, Intervention, Comparator, Outcome” (PICO) questions covering screening, diagnosis, non-pharmacological and pharmacological treatments, and monitoring were formulated. A systematic search of MEDLINE, the Cochrane Database of Systematic Reviews, and Scopus was performed to find network meta-analyses, meta-analyses, systematic reviews, guidelines, and recommendations from scientific societies published in the last 10 years. Manual searches were also performed. Summaries of evidence were provided, and recommendations were further validated by the BBC board members and other national scientific societies’ experts. Results: Of the 3840 references in the search, 333 full texts were assessed for eligibility, and 129 met the inclusion criteria. Osteoporosis screening using clinical risk factors should be considered. Patients with a recent (, SCOPUS: ar.j, info:eu-repo/semantics/published

Vitamin D is a calciotropic hormone with essential roles in postnatal skeletal development as well as mineral homeostasis in the elderly. Severe vitamin D deficiency or genetic defects in vitamin D actions may result in rickets (before epiphyseal growth plate closure) or osteomalacia. Vitamin D is mainly synthesized in the epidermis from cholesterol precursors by ultraviolet B light exposure, followed by conversion to 25-hydroxyvitamin D in liver by CYP2R1 and other cytochrome P450 enzymes. The definition of vitamin D deficiency as well as the role of free vitamin D not bound to vitamin D-binding protein (GC globulin) remains controversial. In the kidney, CYP27B1 converts the 25-hydrovitamin D prohormone to the active metabolite 1,25-dihydroxyvitamin D which acts upon the vitamin D receptor to regulate transcription in target cells. The beneficial skeletal effects of vitamin D are mainly determined by its stimulation of intestinal calcium absorption, prevention of secondary hyperparathyroidism and subsequent increases in bone turnover, as well as reducing the risk of falls in vitamin D-deficient elderly. Remarkably low doses are however needed for these beneficial effects, while very high dose vitamin D supplements may stimulate bone resorption, suppress mineralization, and increase the risk of falls. This chapter will critically discuss basic and clinical aspects of vitamin D related to bone health across the lifespan.

Chronic kidney disease and osteoporosis are major public health problems associated with an aging population. Vitamin K insufficiency is prevalent among patients with end-stage renal disease (ESRD). Preliminary data indicate that poor vitamin K status may compromise bone health and that increased inflammation may be in the causal pathway. We performed an ancillary analysis of data collected in the frame of prospective observational cohort studies exploring various aspects of bone health in de novo renal transplant recipients to investigate the association between vitamin K status, inflammation, bone mineral density, and incident clinical fractures. Parameters of mineral metabolism (including biointact PTH and FGF23, sclerostin, calcidiol, calcitriol) and inflammation (CRP and IL-6), osteoprotegerin, bone turnover markers (P1NP, BsAP, and TRAP5B), and dephosphorylated-uncarboxylated Matrix Gla Protein (dp-ucMGP) were assessed on blood samples collected immediately prior to kidney transplantation in 468 patients. Areal bone mineral density (aBMD) was measured at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry within 14 days posttransplant. Poor vitamin K status, defined by dp-ucMGP >500 nmol/L, was highly prevalent (90%). High dp-ucMGP levels independently associated with elevated inflammatory markers and low aBMD. No associations were observed between vitamin K status and bone turnover markers. During a median follow-up of 5.1 years, 33 patients sustained a fragility fracture. In Cox-proportional hazards analysis, a dp-ucMGP above median associated with incident fractures, independent of classical determinants, including age, gender, history of fracture, and aBMD (HR 2.21; 95% CI, 1.00 to 4.91; p

Osteocyte lacunae are small cavities within the bone matrix. Their dimensions and spatial arrangement affect bone mechanical properties. Furthermore, their size and shape affect the strain in bone tissue close to the lacunae; hence, they are supposed to affect the mechanosensory function of the osteocytes residing in the lacunae. It was the purpose of this study to quantify the morphological features of osteocyte lacunae, whether these are affected by aging and whether these vary among different anatomical location. In addition, we aimed at quantifying the vascular canals as these affect bone's microporosity too. We quantified the microporosity in the fibular midshaft of young-adult and old female C57BL/6 mice. Using micro-computed tomography (μCT), we found that advanced age was associated with a significantly decreased vascular canal number and volume density. In aged mice, the mean volume of the lacuna was significantly smaller than in young animals and they were more round. Lacuna number density close to the neutral axis of the fibula was higher in older mice than in young ones. The characterization of bone microporosity presents a first step in further unraveling their potential role in age-related reductions in bone strength.

The selective estrogen receptor modulator tamoxifen exerts estrogen agonistic or antagonistic actions on several tissues, including bone. The off-target effects of tamoxifen are one of the most widely recognized pitfalls of tamoxifen-inducible Cre recombinases (CreERs), potentially confounding the phenotypic findings. Still, the validation of tamoxifen induction schemes that minimize the side effects of the drug has not been addressed. Here, we compared the side effects on the skeleton and other androgen-responsive targets of a shortened tamoxifen regimen (2 doses of 190 mg/kg body weight by oral gavage) to a standard protocol (4 doses) and determined their efficiency in inducing CreER-mediated gene deletion. In addition, both a vehicle- and a 10-dose group, which served as a positive control for tamoxifen side effects, were also included. For this purpose, we generated male mice with a floxed androgen receptor (AR) and a neuron-specifically expressed CreER. Treatment with two doses of tamoxifen was the only regimen that did not diminish androgenic bioactivity, as assessed by both seminal vesicles and levator ani/bulbocavernosus muscle weights and serum testosterone concentrations. Similarly, trabecular and cortical femoral bone structure were dramatically altered by both the standard and high-dose protocols but not by the shortened version. Serum osteocalcin and bone-gene expression analyses confirmed the absence of effects on bone by 2 doses of tamoxifen. This protocol decreased AR mRNA levels efficiently and specifically in the nervous system. Thus, we optimized a protocol for tamoxifen-induced CreER gene deletion in mice without off-target effects on bone and male reproductive organs.

Patients with chronic kidney disease (CKD) are at increased risk of fractures. The fracture risk steadily increases along with the progression of renal disease to become several-fold higher in end-stage renal disease (ESRD) patients as compared to age and sex-matched controls. Renal osteodystrophy (ROD) is a heterogeneous group of metabolic bone diseases complicating progressive chronic kidney disease. Bone biomarkers and bone imaging techniques may help to assess bone health and predict fractures in CKD, but do have important inherent limitations. The gold standard for the diagnosis and specific classification of renal osteodystrophy (ROD) remains the (quantitative) histomorphometric analysis of the bone biopsy. By informing on bone turnover and mineralization, a bone biopsy may help guide prevention and treatment of ROD and its consequences. This review aims to present an update on epidemiological and procedural aspects, clinical indications, and histomorphometric analysis of bone biopsies and to define the role of bone biopsy in current CKD-MBD care.

The human amniotic membrane (hAM) is an attractive biomaterial for regenerative medicine, as it contains amniotic mesenchymal stromal cells (hAMSC), epithelial cells (hAEC) and growth factors. We examined the potential use of hAM in orthopaedic and maxillofacial bone surgery, integrating the requirements of current regulations regarding advanced therapy medicinal products (ATMP) in the European Union. Previous studies have described the potential osteodifferentiation of intact hAM during whole-tissue culture in osteogenic conditions. The present study aims to determine whether in vitro osteodifferentiation of hAM is needed in the context bone repair, and the influence of this process on tissue structure, cell phenotype and cell function. Different conditions (fresh or cultured hAM; intact or hAM-derived cells) were tested. Phenotypic and functional analyses were performed with standard approaches (cell culture and staining, histological and immunolabelling) as well as original approaches (tissue staining, energy dispersive X-ray and X-ray diffraction). In our study, non-osteodifferentiated hAM (i.e., fresh or native hAM) exhibited innate pre-osteoblastic potential. Osteodifferentiation of fresh hAM induced a change in tissue structure, cell phenotype and function. Therefore, we hypothesize that pre-osteodifferentiation may not be necessary, especially if it induces unwanted changes. To our surprise, in these osteogenic conditions, hAEC had a mesenchymal phenotype with osteocyte function, and even native synthesis of hydroxyapatite, focusing osteogenic potential mainly in this epithelial layer. In conclusion, in vitro osteodifferentiation by tissue culture does not appear to be necessary for hAM to be used as an innovative ATMP for bone repair.

The aim of this study is to analyze the patients' satisfaction after aesthetic abdominal etching or associated with an abdominoplasty.All records of patients who underwent abdominal etching between 2016 and 2017 were analyzed. Eligible patients were contacted, by telephone and submitted to a questionnaire of satisfaction. The patients were then divided into 3 groups according to the operative indication: aesthetic abdominal etching, abdominal etching for breast lipofilling and abdominal etching associated with an abdominoplasty.Twenty-two out of 30 patients agreed to answer the questionnaire: 6 in the aesthetic abdominal etching group, 9 in the breast lipofilling group and 7 in the abdominoplasty group. For 41% of patients, the result was entirely in line with their expectations. It was fairly consistent in 50% of cases and non-compliant in 9% of cases. 50% of the patients were completely satisfied with the stability of the result over time and 45% were quite satisfied, an average satisfaction of 95%. Fourteen percent of patients rated their result as excellent, 41% as very good, 32% as good and 14% as average. No patient rated his result as mediocre. For 96% of patients, the choice of intervention was a good or very good decision and 77% would do it again without hesitation.Abdominal etching provides a high overall patients' satisfaction. It has a positive impact on the patient's life, with a low risk of complications.