Bioarchaeology of adaptation to a marginal environment in bronze age Western China.

OBJECTIVES: This study examines human adaptation to the 4000 BP climate change event, which is said to have increased the marginality of Inner Asian environments. We propose to define "marginal" environments not in relation to a specific economic activity (e.g., agriculture), but in relation to whether humans living there are physiologically stressed. METHODS: Three sites in the Hexi Corridor of Gansu were studied, one from the early and two from the late Bronze Age (N = 125). The study includes three indicators of physiological stress: linear enamel hypoplasias (LEH); tibial periosteal lesions; and fertility. The early and late Bronze Age groups were compared to examine whether human physiological stress increased. RESULTS: The percent of individuals with LEH declined dramatically, indicating fewer growth disruptions. Tibial periosteal reactions also changed, from mostly active to mostly healing at the time of death, indicating that frailty declined. Fertility, which is sensitive to changes in population health and resource availability, did not change significantly. CONCLUSIONS: Counter to the dominant narrative of environmental deterioration and subsistence system collapse, the Bronze Age residents of the Hexi Corridor show no skeletal evidence that they suffered from resource shortages or struggled to adapt in the fluctuating climate that pertained after the 4000 BP climate event. In fact, this study found that people suffered from less frailty and fewer growth disruptions after the unstable climate had persisted for some time. Therefore, in human biological terms, the Hexi Corridor did not become more marginal for human habitation during the Bronze Age.

Plasma fluoride level as a predictor of voriconazole-induced periostitis in patients with skeletal pain.

BACKGROUND: Voriconazole is a triazole antifungal medication used for prophylaxis or to treat invasive fungal infections. Inflammation of the periosteum resulting in skeletal pain, known as periostitis, is a reported side effect of long-term voriconazole therapy. The trifluorinated molecular structure of voriconazole suggests a possible link between excess fluoride and periostitis, as elevated blood fluoride has been reported among patients with periostitis who received voriconazole. METHODS: Two hundred sixty-four patients from Michigan were impacted by the multistate outbreak of fungal infections as a result of contaminated methylprednisolone injections. A retrospective study was conducted among 195 patients who received voriconazole therapy at St Joseph Mercy Hospital during this outbreak. Twenty-eight patients who received both bone scan and plasma fluoride measurements for skeletal pain were included in the statistical analyses. Increased tracer uptake on bone scan was considered positive for periostitis. The primary outcome measure was the correlation between plasma fluoride and bone scan results. RESULTS: Blood fluoride (P < .001), alkaline phosphatase (P = .020), daily voriconazole dose (P < .001), and cumulative voriconazole dose (P = .027) were significantly elevated in patients who had periostitis compared with those who did not. Discontinuation or dose reduction of voriconazole resulted in improvement of pain in 89% of patients. CONCLUSIONS: High plasma fluoride levels coupled with skeletal pain among patients who are on long-term voriconazole therapy is highly suggestive of periostitis. Initial measurement of fluoride may be considered when bone scan is not readily available. Early detection should be sought, as discontinuation of voriconazole is effective at reversing the disease.

Health in post-Black Death London (1350-1538): age patterns of periosteal new bone formation in a post-epidemic population.

Previous research has shown that the Black Death targeted older adults and individuals who had been previously exposed to physiological stressors. This project investigates whether this selectivity of the Black Death, combined with post-epidemic rising standards of living, led to significant improvements in patterns of skeletal stress markers, and by inference in health, among survivors and their descendants. Patterns of periosteal lesions (which have been previously shown, using hazard analysis, to be associated with elevated risks of mortality in medieval London) are compared between samples from pre-Black Death (c. 1,000-1,300, n = 464) and post-Black Death (c. 1,350-1,538, n = 133) London cemeteries. To avoid the assumptions that stress markers alone provide a direct measure of health and that a change in frequencies of the stress marker by itself indicates changes in health, this study assesses age-patterns of the stress marker to obtain a more nuanced understanding of the population-level effects of an epidemic disease. Age-at-death in these samples is estimated using transition analysis, which provides point estimates of age even for the oldest adults in these samples and thus allows for an examination of physiological stress across the lifespan. The frequency of lesions is significantly higher in the post-Black Death sample, which, at face value, might indicate a general decline in health. However, a significant positive association between age and periosteal lesions, as well as a significantly higher number of older adults in the post-Black Death sample more likely suggests improvements in health following the epidemic.

Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients.

BACKGROUND: The aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive protein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: A prospective, cross-sectional, case-control study was conducted in a single hospital-based PD unit. A total of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were divided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group 1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to ≥5 mg/L, n = 45), group 3 (from ≥5 mg/L to <5 mg/L, n = 45), and group 4 (from ≥5 mg/L to ≥5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy indices, and peritonitis risk were compared between the groups. RESULTS: The initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear correlation between the serial albumin change (∆alb) and serial hs-CRP change (∆hs-CRP; r = -0.154, p = 0.005). The hazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401, 95% CI 0.209 - 0.769). Group 2 had a greater serum albumin decline rate (∆alb: -3% ± 9%) and hs-CRP elevation rate (∆hs-CRP: 835% ± 1232%) compared to those for the other groups. CONCLUSIONS: A progressive increase in the hs-CRP level was associated with a corresponding decline in the serum albumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients.

Oral bisphosphonate use increases the risk for inflammatory jaw disease: a cohort study.

PURPOSE: The objective of this study was to address whether among people living in Denmark, those treated with medications to prevent osteoporosis have an increased risk for inflammatory jaw disease compared with those not treated. PATIENTS AND METHODS: A historical cohort study was designed to compare the rate of inflammatory jaw-related events, ie, osteomyelitis, osteitis, periostitis, or sequestrum, between Danish patients who had been prescribed oral bisphosphonates (BP) and other drugs for the treatment of osteoporosis between 1996 and 2006 (the exposed group), and a random sample of the Danish population drawn from a nationwide registry who had not been prescribed oral BPs or other medications to treat osteoporosis (the nonexposed group). The nonexposed subjects were age- and gender-matched to the exposed subjects and randomly drawn from the general population at a ratio of 3 non-BP subjects to 1 BP subject. The primary explanatory variable was oral BP exposure status. Associations between BP treatment and inflammatory jaw events were ascertained using hazard ratios (HR) Cox proportional hazards models. RESULTS: The study sample was composed of 103,562 index subjects and 310,683 control subjects. After adjusting for other factors, including diabetes and chemotherapy, alendronate (HR = 3.15, 95% confidence interval 1.44-6.87) and etidronate (HR = 2.23, 95% confidence interval 1.15-4.31) were associated with an increased risk for inflammatory jaw events. There was no association between oral BP dose and risk for inflammatory jaw events. CONCLUSION: The oral BPs alendronate and etidronate were associated with an increased risk for inflammatory jaw events.

The association between periodontal disease and periosteal lesions in the St. Mary Graces cemetery, London, England A.D. 1350-1538.

Numerous studies have demonstrated significant associations between periodontal disease and many other diseases in living populations, and some studies have shown that individuals with periodontal disease are at elevated risks of mortality. Recent analysis of a medieval skeletal sample from London has also shown that periodontal disease was associated with increased risks of mortality in the past. This study examines whether periodontal disease is associated with periosteal lesions in a skeletal sample from the urban St. Mary Graces cemetery (n = 265) from medieval London. The results reveal a significant association between periodontal disease and periosteal lesions in the St. Mary Graces sample (i.e., individuals with periodontal disease were also likely to have periosteal lesions), and the association between the two is independent of age. The association between the two pathological conditions might reflect underlying reduced immune competence and thus heightened susceptibility to pathogens that cause periodontal disease or periosteal lesions, exposure to an environmental factor, or underlying heightened inflammatory responses.

[Acute mastoiditis: increase of incidence and controversies in antibiotic treatment].

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children's Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital.

[Ocular and orbital complications of paranasal sinusitis]. / Powiklania oczne i oczodolowe zapalenia zatok przynosowych.

PURPOSE: The task of the research was epidemiological and clinical analyses of those patients. MATERIAL AND METHODS: In the period of 1976-200 147 patients with complications of perinasal sinusitis were treated. As numerous classifications of paranasal sinusitis complications exist, the analysis of the material was based on the modified classification proposed by the authors. The frequency of the complications was presented in 5-years periods. RESULTS: There were 133 patients treated due to ocular and orbital complications. In our material there were 79 patients (59.4%) up to 15 years of age and 54 patients (40.6%) older than 15 years. We noted 47 females (35.3%) and 86 males (64.7%). In evaluated 5-years periods the number of patients treated balanced between 17 and 37. In our material dominated orbital periostitis (palpebral edema)--103 cases (77.4%). Subperiosteal abscessus of the orbit was noted in 21 cases (15.8%), inflammation of the orbital tissue--in 5 cases (3.8%), orbital abscessus in 2 cases (1.5%), other rare complications--in 2 cases (1.5%). CONCLUSIONS: Generally the number of patients with ocular and orbital complications of paranasal sinusitis was changing in 5-years periods, but we did not notice any permanent tendency for increase or decrease. In the last 5 years we noted the increase in the number of complications, which was connected with the increase of the number of patients treated for orbital periostitis. In 2 patients we found rare orbital and ocular complications, that were not included in existing classifications. These were: orbital subperiosteal haematoma and episcleritis.

Epidemiology of odontogenic periostitis.

The frequency of odontogenic periostitis (o.p.) observed during 13 consecutive years was assessed according to sex, age, and the affected pairs of teeth, in subjects admitted to an outpatient department in an area with an unsatisfactory dentist/population ratio. O.p. was less frequent in the older age groups, even after adjustment for the decreasing number of subjects with advancing age. The observed frequencies of o. p. were related in groups with a range of 10 years, both in men and women to the number of teeth present, i. e. "at risk". The last-mentioned figures were calculated for the individual pairs of teeth relying on a population model. the maximum risk of the individual tooth pairs was not found for all teeth in the same age classes but varied, partly in accordance with the caries susceptibilities, though this item was not the determining factor. O. p. is an avoidable sequel of penetrating caries, and as such is one of the consequences of the inadequate health education of the public.

Periosteal ganglion: a report of three new cases including MRI findings and a review of the literature.

OBJECTIVE: To clarify the clinicopathological features of periosteal ganglion. DESIGN: Three patients with periosteal ganglion were studied clinicopathologically. PATIENTS: One patient was selected from the files of our institute and two from a consultation file. RESULTS AND CONCLUSION: All three lesions were located over the medial aspect of the tibia. Plain radiographs showed cortical erosions of varying degrees and mild periosteal reaction of the medial side of the tibia. MR images demonstrated well-circumscribed lesions overlying the cortical bone of the tibia, shown as low-intensity areas on T1-weighted images. On T2-weighted images, lesions were homogeneous, lobulated, and showed a characteristic markedly increased signal intensity. These findings are helpful in making a diagnosis of periosteal ganglion. Each patient had an uneventful clinical course after an excision involving the wall of the ganglion, the adjoining periosteum, and the underlying sclerotic cortical bone.

Incidence of osteoperiostitis of the great toe in psoriatic arthritis.

OBJECTIVE: To assess the incidence of osteoperiostitis of the distal phalanx of the great toe in psoriatic arthritis (PsA). METHODS: One thousand great toes (202 of PsA, 44 of cutaneous psoriasis, 274 of low back pain patients, 296 of rheumatoid arthritis, 136 of spondyloarthropathy, and 48 of connective tissue diseases) were studied for osteoperiostitis of the distal phalanx of the great toe (slight, moderate, or severe), destructive joint lesions of the feet, nail dystrophy, fungal infection, and HLA-B type (patients with PsA). RESULTS: Osteoperiostitis was observed in 92 great toes. Moderate and severe osteoperiostitis were observed only in PsA. Osteoperiostitis was statistically more frequent in PsA (53/202, 26.2%, especially in those with onychosis: 20/41, 48.8%) than in other groups (39/798, 4.9%) (p < 0.01). In PsA, osteoperiostitis was more frequent in patients with nail dystrophy (20/41, 48.8%) than in patients without (33/161, 20.5%) (p < 0.05). Fungal infection of the nail and HLA haplotype were not associated with osteoperiostitis. In patients with PsA, osteoperiostitis was associated with destructive joint lesions of the feet. CONCLUSION: Osteoperiostitis of the distal phalanx of the great toe is an enthesopathy evocative of PsA.

The frequency and diagnostic significance of periostitis in chondroblastoma.

A study was performed to determine the frequency of periosteal reaction associated with chondroblastoma, to investigate the underlying pathophysiology of the periosteal reaction, and to postulate the clinical importance of this radiographic observation. Two hundred fourteen histologically proved chondroblastomas were reviewed and observed for the presence or absence of periosteal reaction and for radiographic changes that might explain the cause of the periosteal reaction. A similar review was performed on 30 other epiphyseally centered lesions of various causes. A distinctive thick, solid periosteal reaction distal to the chondroblastoma was present in 47% of all chondroblastomas and 57% of chondroblastomas present in long bones (excluding the greater trochanter). No periosteal reaction was observed in any of the 30 epiphyseally centered lesions of other causes. When available for observation, plain films showed inflammatory changes in the joint surrounding the chondroblastoma, bone scintigraphy showed tracer uptake similar to that observed in inflammatory lesions and aggressive neoplasms, and MR images showed change in the marrow surrounding the chondroblastoma consistent with edema. This suggests an inflammatory reaction to the chondroblastoma, rather than mechanical stress across a weakened epiphysis, as the cause of the periostitis. We conclude that frequently the chondroblastoma produces a distinctive thick solid or layered periosteal response distant from the lesion along the diametaphyseal shaft. Observation of this unique periosteal response may help to distinguish chondroblastoma from other epiphyseally centered lesions.

Rib lesions in a prehistoric Puebloan sample from southwestern Colorado.

An unusually high frequency of periosteal lesions of visceral rib surfaces was observed in a small, prehistoric skeletal series from southwestern Colorado. Lesions of this type have been concordant with pulmonary tuberculosis in three studies of human skeletal collections with known cause of death, and in a recent clinical investigation of rib dimensions in living patients with lung disorders. Diseases such as pneumonia and actinomycosis have also been found to cause these lesions, but in much lower frequencies. Archaeological evidence suggests that Puebloan farmers of Sleeping Ute Mountain's southern piedmont, from which the sample is drawn, endured unusually harsh environmental conditions punctuated by severe drought and exacerbated by escalating warfare. It is argued here that these environmental stressors increased susceptibility to an opportunistic respiratory infection reminiscent of tuberculosis, and possibly also some form of pneumonia, resulting in high rates of active disease previously noted only in historic Puebloan peoples.

Acute mastoiditis: Increase of incidence and controversies in antibiotic treatment

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children’s Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital

La mastoiditis aguda es una complicación importante de la otitis media aguda que responde al tratamiento antibiótico y la miringotomía. Se realizó un estudio de revisión de los pacientes con mastoiditis aguda que acudieron al Hospital Infantil Universitario Niño Jesús de Madrid, de nivel terciario, durante 1996-2005. El número de pacientes con mastoiditis aguda aumentó aproximadamente dos veces durante este periodo. De los 205 niños registrados con mastoiditis, con una edad de 0,6 a 17 años, se requirió tratamiento quirúrgico en cerca del 4,3% en 1996 y en el 70% en 2005. A pesar de que el 80% de los niños recibieron antibióticos al visitar al pediatra, el número de complicaciones aumentó (periostitis, absceso subperióstico) y el número de intervenciones quirúrgicas fue hasta ocho veces superior. Los agentes etiológicos identificados fueron Streptococcus pneumoniae (28,5%) y Staphylococcus aureus (16,3%). Los cultivos fueron negativos en el 53,6% de los casos. Según la tendencia observada en nuestro hospital, la falta de respuesta a un tratamiento convencional puede requerir un mayor número de procedimientos de timpanocentesis para los cultivos de oído medio y la necesidad de realizar un tratamiento quirúrgico con mayor frecuencia