Precision Errors and Monitoring Time Interval in Pediatric Muscle Imaging and Neuromuscular Performance Assessment.

OBJECTIVES: To determine precision errors and monitoring time intervals in imaged muscle properties and neuromuscular performance, and to explore growth-related factors associated with precision errors in children. METHODS: We included 35 children (mean age 10.5yrs) in the precision study cohort and 40 children (10.7yrs) in the follow-up study cohort. We assessed forearm and lower leg muscle properties (area, density) with peripheral quantitative computed tomography. We measured neuromuscular performance via maximal pushup, grip force, countermovement and standing long jump force, power, and impulse along with long jump length. We calculated precision errors (root-mean-squared coefficient of variation) from the precision cohort and monitoring time intervals using annual changes from the follow-up cohort. We explored associations between precision errors (coefficient of variation) and maturity, time interval (between repeated measures), and anthropometric changes using Spearman's rank correlation (p<0.05). RESULTS: Muscle measures exhibited precision errors of 1.3-14%. Monitoring time intervals were 1-2.6yrs, except muscle density (>43yrs). We identified only one association between precision errors and maturity (maximal pushup force: rho=-0.349; p=0.046). CONCLUSIONS: Imaging muscle properties and neuromuscular performance measures had precision errors of 1-14% and appeared suitable for follow-up on ~2yr scales (except muscle density). Maximal pushup force appeared more repeatable in mature children.

Increased serum interleukin-37 (IL-37) levels correlate with oxidative stress parameters in Hashimoto's thyroiditis.

PURPOSE: Interleukin-37 (IL-37), member of the IL-1 family, is a natural suppressor of immune and inflammatory responses. Increased serum IL-37 levels were observed in several autoimmune diseases, including Graves' disease. To our knowledge, no data on Hashimoto's thyroiditis (HT) are available in the literature. METHODS: Aim of our study was to measure serum IL-37 levels and evaluate their relationship, if any, with oxidative stress markers in HT patients. We enrolled 45 euthyroid HT patients (5 M e 40 F, median age 40 years) and 50 age- and sex-matched healthy controls. None was under L-thyroxine therapy. Serum IL-37 levels were measured by ELISA. Specific serum tests, such as derived reactive oxygen metabolites (d-ROMs), and biological anti-oxidant potential (BAP) test were performed in all subjects to investigate the changes in oxidative balance, and advanced glycation end products (AGEs) were determined as a specific marker of oxidative stress. RESULTS: IL-37 levels were significantly higher in HT than in controls (median 475 vs. 268 pg/ml, P = 0.018). In the same patients, serum oxidants (d-ROMs) were increased and anti-oxidants (BAP) decreased compared with controls (P = 0.011 and < 0.0001, respectively), clearly indicating an enhanced oxidative stress. In addition, AGEs levels were higher in HT patients than in controls (210 vs. 140 AU/g prot, P < 0.0001) and directly correlated with IL-37 levels (P = 0.048). At multivariate analysis, the main independent predictors that influenced IL-37 levels were both anti-thyroid antibodies (P = 0.026) and AGEs levels (P = 0.001). CONCLUSIONS: IL-37 is up-regulated in HT and may exert a protective role by counteracting oxidative stress and inflammation.

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density.

BACKGROUND: Subchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The objective of this study was to use QCT-based image-processing techniques to characterize subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA. METHODS: The preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. We used Spearman's correlation coefficients to explore associations between patient characteristics and cyst parameters. RESULTS: At both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. At the lateral region, cyst number and volume were also associated with lateral OA severity, lateral JSN, alignment and sex. Pain was not associated with any cyst parameters at any region. CONCLUSION: Cyst number and volume were associated with BMD at both the medial and lateral compartments. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics.

Alpha-lipoic acid, but not di-hydrolipoic acid, activates Nrf2 response in primary human umbilical-vein endothelial cells and protects against TNF-α induced endothelium dysfunction.

The antioxidants role in cell response regulation attracted great interest in the last decades and it is undergoing to a profound reconsideration. The mere concept of "biological antioxidant" has been frequently misconceived or misused, possibly leading to the misinterpretation of some experimental observation. Organosulfur compounds in general and α-lipoic acid, a dithiol molecule, can be considered a typical example of the kind. Reduced α-lipoic acid, dehydrolipoic acid has been in fact originally considered a bona fide, reducing, electron donor molecule. A more recent approach, according to stoichiometric and thermodynamic evidences, lead to a reinterpretation of the biochemical role of "antioxidants". The electrophilic nature of oxidized nucleophilic molecules, including α-lipoic acid, renders more plausible a mechanism based on the ability to activate Nrf2/EpRE mediated hormetic response. In this study, we demonstrate that nmolar concentrations of oxidized α-lipoic acid, but not dehydrolipoic acid, protect human umbilical primary endothelial cells (HUVEC) from TNF-α induced dysfunction, inhibit NF-κB activation and block apoptosis following the activation of Nrf2 transcription factor. Our observations corroborate the concept that the major, if not the unique, mechanism by which α-lipoic acid can non-enzymatically exert its reducing activity is related to the electrophilic nature of the oxidized form.

Experimental exposure of blue mussels (Mytilus galloprovincialis) to high levels of benzo[a]pyrene and possible implications for human health.

Polycyclic aromatic hydrocarbons (PAHs) are lipophilic compounds able to accumulate in the food chain. Mussels showed to bioaccumulate contaminants, such as PAHs, so that recurrent consumption of such contaminated food represents a risk for human health. This study was aimed to elucidate if acute exposure of Mediterranean blue mussel (Mytilus galloprovincialis), a bivalve of great economic importance in several countries, to a PAH, benzo[a]pyrene (B[a]P), at doses able to induce cytochrome P450 1A (CYP1A) and pathological changes in mussel gills, can produce accumulation in soft tissue. We explored the cytotoxic effects (cell viability, DNA laddering, and glutathione levels) of in vitro exposure of human peripheral blood mononuclear cells (PBMCs) to organic extracts obtained from blue mussels previously exposed for 12 and 72h via water to B[a]P (0.5-1mg/L). In our experimental conditions, B[a]P induced CYP1A induction and morphological changes in mussel gills and a significant B[a]P accumulation in soft tissue. Conversely, exposing PBMCs to organic extracts obtained from contaminated mussels, resulted in a significant reduction of cell viability and cell glutathione content, and in an increase in DNA laddering. This confirms that consumption of mussels from B[a]P polluted waters might affect human health. Our data lead us to suggest that CYP1A activity in mussel gills may be useful (more than the amount of detected PAHs in the mussel edible tissue) as a marker in assessment of risk for health of consumers exposed to PAHs through ingestion of shellfish.

Differences in Function and Fracture Risk in Postmenopausal Women With and Without a Recent Distal Radius Fracture.

A distal radius fracture (DRF) is commonly the first fracture to occur in early postmenopausal women. The reasons for sustaining a DRF may be related to fall risk, bone fragility, or both. The objective of this study was to compare functional and fracture risk status in postmenopausal women with and without a recent DRF and explore the relationships between function, grip strength, and fracture risk status. Seventy-seven women a ges 50-78 with (n = 32) and without (n = 45) a history of DRF in the past 2 years participated. Balance, timed up and go (TUG), gait velocity, balance confidence, sit to stand, grip strength, and fracture risk were assessed. There was a significant group difference after controlling for physical activity level (Pillai's Trace, p < .05) where women with DRF had poorer outcomes on sit to stand, gait velocity, TUG, and fracture risk status. Grip strength was associated with functional tests, particularly in women with DRF. Women with a recent DRF demonstrated lower functional status and higher fracture risk compared to women without. Grip strength was associated with measures of function and fracture risk, and may complement screening tools for this population.

Oxidative stress markers are increased in patients with mastocytosis.

BACKGROUND: Mastocytosis is characterized by clonal proliferation of mast cells limited to the skin (cutaneous mastocytosis: CM and mastocytosis in the skin: MIS) and/or involving internal organs (systemic mastocytosis: SM). Oxidative stress occurring in various inflammatory and neoplastic disorders causes molecular damage with the production of advanced oxidation protein products (AOPPs) and advanced glycation end products (AGEs). We evaluated these markers of oxidative stress in patients with CM/MIS and SM and correlated their levels with the presence of symptoms related to mast cell activation. METHODS: Serum levels of AOPPs and AGEs in 34 patients with mastocytosis (23 CM/MIS and 11 SM) and 27 healthy controls were measured by spectrofluorimetric and spectrophotometric methods. Serum tryptase levels were measured by immunofluorescence. RESULTS: Serum AOPPs, but not AGEs, were significantly higher in patients with mastocytosis as compared to healthy controls. While serum tryptase levels were higher in patients with SM as compared to those with CM/MIS, there was no difference in AOPP and AGE concentrations between these two groups of patients. Patients with recurrent mediator-related symptoms had lower AOPPs and AGEs as compared to patients without symptoms. AOPPs and AGEs were inversely correlated with the severity of symptoms, and in patients with symptoms, AOPPs correlated with tryptase levels. DISCUSSION: Our data show that mastocytosis is associated with a state of increased oxidative stress that, in patients with mediator-related symptoms, correlates with mast cell burden as assessed by tryptase. Patients with symptoms presumably have an adaptive response resulting in lower blood levels of AOPPs and AGEs.

Exposure of sea bream (Sparus aurata) to toxic concentrations of benzo[a]pyrene: possible human health effect.

Polycyclic aromatic hydrocarbons (PAHs) can accumulate in the food chain, due to their lipophilic properties. Fish can accumulate contaminants including PAHs and frequent consumption of such contaminated fish can pose risk to human health. The aim of this study was to clarify if acute exposure of sea bream (Sparus aurata, a fish species of great economic importance in the Atlantic and Mediterranean areas) to a PAH, benzo[a]pyrene (B[a]P), at a dose that can induce CYP1A and pathological changes in fish gills, liver and muscle, can induce accumulation in muscle. We investigated the cytotoxic effects (as changes in cell viability, DNA laddering and glutathione content) of in vitro exposure of human peripheral blood mononuclear cells (PBMCs) to organic extracts obtained from muscle of sea breams previously exposed via water to B[a]P (2mg/l, for 12, 24 and 72 h). At this level of exposure, B[a]P caused morphological changes, inflammatory response and CYP1A induction not only in sea bream gills and liver but also in muscle; furthermore, in fish muscle we observed a substantial B[a]P accumulation, which may be associated with the increased CYP1A activity in liver and especially in muscle. However, when PBMCs were exposed to organic extracts obtained from sea bream muscle contaminated with B[a]P, a toxic, although modest effect was revealed, consisting in a significant decrease in cell glutathione levels without alterations in cell viability and DNA laddering. This suggests that consumption of sea breams from B[a]P contaminated waters might represent a risk for human health.

Increased serum interleukin-22 levels in patients with PRL-secreting and non-functioning pituitary macroadenomas.

Cytokines' involvement in tumorigenesis has been hypothesized. Interleukin-22 (IL-22) is implicated in proliferative and anti-apoptotic pathways via its receptor IL-22R. Its role in pituitary adenomas has never been investigated. Twenty-seven patients with pituitary macroadenomas (PA, 21 males, mean age 53.8 ± 14.4 years) and 30 healthy controls (19 males, mean age 50.4 ± 8.4 years) were enrolled. Out of 27 PA patients, 17 had a non-functioning tumour (NFPA) and 10 a PRL-secreting adenoma (PRL-oma). Serum IL-22 levels were measured in both patients and controls. Immunohistochemical (IHC) tumoral IL-22R expression was evaluated in 10 patients with NFPA and 4 with PRL-oma. IL-22 levels were significantly higher in PA patients than in controls [32.47 (11.29-70.12) vs. 5.58 (0.19-21.46) pg/mL, p < 0.0001] but did not correlate with tumor maximum diameter and were not associated to pituitary function impairment. PRL-oma patients had significantly higher IL-22 levels than NFPA patients [37.18 (14.82-70.12) vs. 21.29 (11.29-56) pg/mL, p = 0.039]. IHC revealed a strong IL-22R staining in 100 % of PRL-omas and 60 % of NFPAs. We provide the first evidence of increased serum IL-22 levels in patients with pituitary macroadenoma, especially in PRL-omas, regardless of tumor size and/or degree of pituitary function impairment. We also demonstrated the expression of IL22R in all PRL-omas and in 60 % of NFPAs.

Comparison of short-term in vivo precision of bone density and microarchitecture at the distal radius and tibia between postmenopausal women and young adults.

The purpose was to assess whether precision of bone properties derived via the use of high-resolution peripheral quantitative computed tomography (HR-pQCT) differs between postmenopausal women and young adults. Using HR-pQCT, we scanned the distal radius and tibia at 2 time points in 34 postmenopausal women (74 ± 7 years) and 30 young adults (mean age ± SD: 27 ± 9 years). Standard protocols were used to acquire bone area, density, and microarchitectural properties. We calculated coefficients of variation (CV; percentage CV and percentage CV of the root mean square) and 95% limits of agreement (95% LOA) to assess precision errors. The 95% LOA is the magnitude of individual change needed to be observed to ensure that a real change has occurred. Multiple Mann-Whitney U-tests (with the use of Bonferroni correction for multiple comparisons) were used to compare percentage CV between the 2 groups. Significance was set to p < 0.004. All standard outcome variables were not significantly different between the groups. The 95% LOA confirmed that the measurement bias between the groups did not differ. These results suggest that short-term precision errors in HR-pQCT-derived bone outcomes are similar between postmenopausal women and young adults.

Velocity-specific strength recovery after a second bout of eccentric exercise.

A bout of eccentric exercise (ECC) has the protective effect of reducing muscle damage during a subsequent bout of ECC known as the "repeated bout effect" (RBE). The purpose of this study was to determine if the RBE is greater when both bouts of ECC are performed using the same vs. different velocity of contraction. Thirty-one right-handed participants were randomly assigned to perform an initial bout of either fast (3.14 rad·s [180°·s]) or slow (0.52 rad·s [30°·s]) maximal isokinetic ECCs of the elbow flexors. Three weeks later, the participants completed another bout of ECC at the same velocity (n = 16), or at a different velocity (n = 15). Indirect muscle damage markers were measured before, immediately after, and at 24, 48, and 72 hours postexercise. Measures included maximal voluntary isometric contraction (MVC) strength (dynamometer), muscle thickness (MT; ultrasound), delayed onset muscle soreness (DOMS; visual analog scale), biceps and triceps muscle activation amplitude (electromyography), voluntary activation (interpolated twitch), and twitch torque. After the repeated bout, MVC strength recovered faster compared with the same time points after the initial bout for only the same velocity group (p = 0.017), with no differences for all the other variables. Irrespective of velocity, MT and DOMS were reduced after the repeated bout compared with that of the initial bout at 24, 48, and 72 hours with a corresponding increase in TT at 72 hours (p < 0.05). Faster recovery of isometric strength associated with a repeated bout of ECC was evident when the velocity was matched between bouts, suggesting that specificity effects contribute to the RBE. The current findings support the idea of multiple mechanisms contributing to the RBE.

Magnetic resonance imaging based finite element modelling of the proximal femur: a short-term in vivo precision study.

Proximal femoral fractures are a serious life-threatening injury with high morbidity and mortality. Magnetic resonance (MR) imaging has potential to non-invasively assess proximal femoral bone strength in vivo through usage of finite element (FE) modelling (a technique referred to as MR-FE). To precisely assess bone strength, knowledge of measurement error associated with different MR-FE outcomes is needed. The objective of this study was to characterize the short-term in vivo precision errors of MR-FE outcomes (e.g., stress, strain, failure loads) of the proximal femur for fall and stance loading configurations using 13 participants (5 males and 8 females; median age: 27 years, range: 21-68), each scanned 3 times. MR-FE models were generated, and mean von Mises stress and strain as well as principal stress and strain were calculated for 3 regions of interest. Similarly, we calculated the failure loads to cause 5% of contiguous elements to fail according to the von Mises yield, Brittle Coulomb-Mohr, normal principal, and Hoffman stress and strain criteria. Precision (root-mean squared coefficient of variation) of the MR-FE outcomes ranged from 3.3% to 11.8% for stress and strain-based mechanical outcomes, and 5.8% to 9.0% for failure loads. These results provide evidence that MR-FE outcomes are a promising non-invasive technique for monitoring femoral strength in vivo.

Differences in the behavior of advanced glycation end products and advanced oxidation protein products in patients with allergic rhinitis.

BACKGROUND: The presence of oxidative stress in patients with asthma is well documented; however, the role of oxidative stress in allergic rhinitis has received less attention, although it is likely to be similar to that observed in patients with asthma. Advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) are compounds formed by the transformation of macromolecules, including proteins, which can serve as densitometric markers of oxidative stress and inflammation in several diseases. OBJECTIVE: The aim of this study was to investigate the role of AGEs and AOPPs as new markers of oxidative stress and inflammation in patients affected by allergic rhinitis. METHODS: AGE and AOPP levels were determined in the sera of 25 patients with allergic rhinitis and 64 healthy controls. AGEs and AOPPs were detected using spectrofluorimetry and spectrophotometry, respectively. RESULTS: AGE levels in patients were significantly higher than those in controls (P < .0001). These levels were not affected by the presence of asthma. No statistically significant differences were found between AOPP levels in patients or controls (P = .38). CONCLUSIONS: Formation of AGEs and AOPPs may be accelerated in immunological and respiratory disorders such as asthma. Depending on the marker evaluated, the presence or absence of oxidative stress in allergic rhinitis is controversial. To our knowledge, this is the first study showing the possible involvement of AGEs in allergic rhinitis. The different behavior observed for these 2 biomarkers is very likely due to the activation of specific related biochemical pathways (eg, the myeloperoxidase pathway) associated with the condition under study.

Fractional anisotropy and mean diffusivity parameters of the brain white matter tracts in preterm infants: reproducibility of region-of-interest measurements.

BACKGROUND: Diffusion tensor parameters can be analysed by fitting regions of interest (ROIs) to selected brain structures. The clinical usefulness of these measurements is influenced by their reproducibility and validity. OBJECTIVE: To investigate the reproducibility of fractional anisotropy (FA) and mean diffusivity (MD) measurements. MATERIAL AND METHODS: Seventy-six infants were imaged once at term-equivalent age. We measured several brain regions. Reproducibility was assessed using intraclass correlation coefficient and Bland-Altman method. RESULTS: Intra-observer reproducibility was excellent for FA in the calcarine cortex (right) and frontal white matter (left), and for MD in the corpus callosum (anterior), internal capsule, corona radiata, putamen, frontal white matter, optic radiation (left), thalamus (right) and calcarine cortex (right). Inter-observer reproducibility was excellent for FA in the corpus callosum (posterior) and for MD in the internal capsule and corona radiata (right). Inter-observer reproducibility was poor for FA in frontal and posterior white matter (right) and for MD in the inferior colliculus (right). Reproducibility was fair to good in other areas. The Bland-Altman plots showed no considerable bias, and variance was independent of the mean value. CONCLUSION: Reproducibility of ROI measurement was fair to good for both FA and MD.

The adhesion molecule ICAM-1 is overexpressed in patients with Hymenoptera venom allergy and decreases after ultrarush venom immunotherapy.

Adhesion molecules, including ICAM-1, are an important factor in allergic inflammation caused by inhalant allergens, but there are no studies investigating their possible role in Hymenoptera venom allergy (HVA). We measured the level of ICAM-1 in 13 venom-allergic patients before and after ultra-rush venom immunotherapy (VIT). Eight patients were treated by yellow jacket venom and 5 were treated by honeybee venom. Serum ICAM-1 levels were assayed by an immunoenzymatic method, with a detection limit of 0.35 ng/ml. The mean level of ICAM-1 changed from 316.4±78.2 ng/ml before VIT to 294.7±77.9 after VIT. This difference was statistically significant (p = 0.019). These findings show that in patients with HVA there is an over-expression of ICAM-1, and that ultra-rush VIT significantly decreases ICAM-1 levels. It is likely that the known ability of VIT to correct the imbalance in T lymphocytes subpopulations and in the associated production of cytokines may account for this observation. In fact, such cytokines include IL-4 and TNF-alpha, that up-regulate adhesion molecules.

A comparison of conventional maximum intensity projection with a new depth-specific topographic mapping technique in the CT analysis of proximal tibial subchondral bone density.

OBJECTIVE: The objective was to identify subchondral bone density differences between normal and osteoarthritic (OA) proximal tibiae using computed tomography osteoabsorptiometry (CT-OAM) and computed tomography topographic mapping of subchondral density (CT-TOMASD). MATERIALS AND METHODS: Sixteen intact cadaver knees from ten donors (8 male:2 female; mean age:77.8, SD:7.4 years) were categorized as normal (n = 10) or OA (n = 6) based upon CT reconstructions. CT-OAM assessed maximum subchondral bone mineral density (BMD). CT-TOMASD assessed average subchondral BMD across three layers (0-2.5, 2.5-5 and 5-10 mm) measured in relation to depth from the subchondral surface. Regional analyses of CT-OAM and CT-TOMASD included: medial BMD, lateral BMD, and average BMD of a 10-mm diameter area that searched each medial and lateral plateau for the highest "focal" density present within each knee. RESULTS: Compared with normal knees, both CT-OAM and CT-TOMASD demonstrated an average of 17% greater whole medial compartment density in OA knees (p < 0.016). CT-OAM did not distinguish focal density differences between OA and normal knees (p > 0.05). CT-TOMASD focal region analyses revealed an average of 24% greater density in the 0- to 2.5-mm layer (p = 0.003) and 36% greater density in the 2.5- to 5-mm layer (p = 0.034) in OA knees. CONCLUSIONS: Both CT-OAM and TOMASD identified higher medial compartment density in OA tibiae compared with normal tibiae. In addition, CT-TOMASD indicated greater focal density differences between normal and OA knees with increased depth from the subchondral surface. Depth-specific density analyses may help identify and quantify small changes in subchondral BMD associated with OA disease onset and progression.

Off-axis loads cause failure of the distal radius at lower magnitudes than axial loads: A side-to-side experimental study.

Off-axis loading associated with a fall onto the outstretched hand has been hypothesized to induce distal radius failure at lower magnitudes than axially directed loading commonly used in biomechanical models for estimating fracture risk. However, this hypothesis has not been tested with side-to-side experimental testing. The objective of this study was to compare distal radius failure loads between forearm pairs experimentally tested in an axial or off-axis loading configuration. We acquired 18 pairs of cadaveric forearms from 18 female donors (mean age (standard deviation): 84.4 (7.9) years). Each forearm pair was tested to failure using either an axial compression test (vertical orientation with 0° dorsal inclination, 3°-6° radial inclination) or an off-axis test corresponding to the hand position during a fall (15° dorsal inclination, 3°-6° radial inclination). Failure testing was performed at 3 mm/s onto the palm of the hand until fracture occurred. Of the 18 pairs, 11 sustained a distal radius fracture. We compared failure loads between the two groups using a paired t test. Results indicated that failure load under off-axis loading was 29% lower than failure load under axial compressive loading (mean difference: -0.31 kN; 95% confidence interval: -0.47 to -0.16 kN, P = .001). In conclusion, off-axis loading associated with a fall onto the outstretched hand resulted in a 29% lower failure load. Integrating an off-axis loading configuration into current biomechanical models of distal radius bone strength may prevent overestimating of failure load and may offer a clinically relevant option to estimate distal radius fracture risk and monitor therapy efficacy.

Distal radius sections offer accurate and precise estimates of forearm fracture load.

BACKGROUND: Forearm fracture risk can be estimated via factor-of-risk: the ratio of applied impact force to forearm fracture load. Simple techniques are available for estimating impact force associated with a fall; estimating forearm fracture load is more challenging. Our aim was to assess whether failure load estimates of sections of the distal radius (acquired using High-Resolution peripheral Quantitative Computed Tomography and finite element modeling) offer accurate and precise estimates of forearm fracture load. METHODS: We scanned a section of the distal radius of 19 cadaveric forearms (female, mean age 83.7, SD 8.3), and 34 women (75.0, 7.7). Sections were converted to finite element models and failure loads were acquired for different failure criteria. We assessed forearm fracture load using experimental testing simulating a fall on the outstretched hand. We used linear regression to derive relationships between ex vivo forearm fracture load and finite element derived distal radius failure load. We used derived regression coefficients to estimate forearm fracture load, and assessed explained variance and prediction error. We used root-mean-squared coefficients of variation to assess in vivo precision errors of estimated forearm fracture load. FINDINGS: Failure load estimates of sections of the distal radius, used in conjunction with derived regression coefficients, explained 89-90% of the variance in experimentally-measured forearm fracture load with prediction errors <6.8% and precision errors <5.0%. INTERPRETATION: Failure load estimates of distal radius sections can reliably estimate forearm fracture load experienced during a fall. Forearm fracture load estimates can be used to improve factor-of-risk predictions for forearm fracture.

Effect of a low dose of sea buckthorn berries on circulating concentrations of cholesterol, triacylglycerols, and flavonols in healthy adults.

BACKGROUND: Epidemiological studies indicate beneficial effects of flavonoids on cardiovascular disease (CVD) risk. AIM OF THE STUDY: To study the effect of flavonoid-rich sea buckthorn berry (SBB) on circulating lipid markers associated with CVD risk and plasma flavonol concentration. Also investigated was whether changes in the circulating flavonol concentrations correlate with the SBB induced changes in C-reactive protein (CRP) concentration observed previously. SUBJECTS AND METHODS: In all 229 healthy participants completed the randomized double-blind study and consumed daily 28 g of SBB or placebo for 3 months. Fasting blood samples for the analysis of lipid markers and flavonols were obtained at the beginning and end of the study. RESULTS: Compared to the placebo, the consumption of SBB increased the plasma concentration of the flavonols quercetin and isorhamnetin significantly [treatment differences 3.0 ng/ml (P = 0.03) and 3.9 ng/ml (P < 0.01), respectively]. The increase of kaempferol concentration was not significant [treatment difference 0.7 ng/ml (P = 0.08)]. SBB did not affect the serum total, HDL, LDL cholesterol, or the serum triacylglycerol concentrations. There was no correlation between the changes in flavonol and CRP concentrations of participants. CONCLUSIONS: The consumption of SBB significantly increased the fasting plasma concentration of quercetin and isorhamnetin indicating that it is a good dietary source of flavonols. However, this did not convert to affecting the circulating concentrations of lipid markers in healthy, normolipidemic adults having healthy diets.

Cortical porosity assessment in the distal radius: A comparison of HR-pQCT measures with Synchrotron-Radiation micro-CT-based measures.

OBJECTIVE: To determine the agreement between cortical porosity derived from high resolution peripheral quantitative computed tomography (HR-pQCT) (via standard threshold, mean density and density inhomogeneity methods) and synchrotron radiation micro-CT (SR-µCT) derived porosity at the distal radius. METHODS: We scanned 10 cadaveric radii (mean donor age: 79, SD 11 years) at the standard distal region using HR-pQCT and SR-µCT at voxel sizes of 82 µm and 17.7 µm, respectively. Common cortical regions were delineated for each specimen in both imaging modalities. HR-pQCT images were analyzed for cortical porosity using the following methods: Standard threshold, mean density, and density inhomogeneity (via recommended and optimized equations). We assessed agreement in porosity measures between HR-pQCT methods and SR-µCT by reporting predicted variance from linear regression and mean bias with limits of agreement (LOA). RESULTS: The standard threshold and mean density methods predicted 85% and 89% of variance and indicated underestimation (mean bias -9.1%, LOA -15.9% to -2.2%) and overestimation (10.4%, 4.6% to 16.2%) of porosity, respectively. The density inhomogeneity method with recommended equation predicted 89% of variance and mean bias of 14.9% (-4.3 to 34.2) with systematic over-estimation of porosity in more porous specimens. The density inhomogeneity method with optimized equation predicted 91% of variance without bias (0.0%, -5.3 to 5.2). CONCLUSION: HR-pQCT imaged porosity assessed with the density inhomogeneity method with optimized equation indicated the best agreement with SR-µCT derived porosity.