Marijuana Use and the Risk of Early Ischemic Stroke: The Stroke Prevention in Young Adults Study.

BACKGROUND AND PURPOSE: Few studies have examined the dose-response and temporal relationships between marijuana use and ischemic stroke while controlling for important confounders, including the amount of tobacco smoking. The purpose of our study was to address these knowledge gaps. METHODS: A population-based case-control study with 1090 cases and 1152 controls was used to investigate the relationship of marijuana use and early-onset ischemic stroke. Cases were first-ever ischemic stroke between the ages of 15 and 49 identified from 59 hospitals in the Baltimore-Washington region. Controls obtained by random digit dialing from the same geographic region were frequency-matched to cases by age, sex, region of residence and, except for the initial study phase, race. After excluding subjects with cocaine and other vasoactive substance use, the final study sample consisted of 751 cases and 813 controls. All participants underwent standardized interviews to characterize stroke risk factors and marijuana use. Unconditional logistic regression analysis was used to assess the relationships between marijuana use and risk of ischemic stroke, adjusting for age, sex, race, study phase, the amount of current tobacco smoking, current alcohol use, hypertension, and diabetes. RESULTS: After adjusting for other risk factors, including the amount of current tobacco smoking, marijuana use was not associated with ischemic stroke, regardless of the timing of use in relationship to the stroke, including ever use, use within 30 days, and use within 24 hours. There was a nonsignificant trend towards increased stroke risk among those who smoked marijuana at least once a week (odds ratio, 1.9 [95% CI, 0.8-4.9]). CONCLUSIONS: These analyses do not demonstrate an association between marijuana use and an increased risk of early-onset ischemic stroke, although statistical power was limited for assessing the association among very heavy users.

Intracerebral Hemorrhage in Multiple Sclerosis: A Retrospective Cohort Study.

BACKGROUND: To identify the vascular risk factors associated with the occurrence of intracerebral hemorrhage (ICH) in Multiple Sclerosis (MS) patients. METHODS: This is an observational, retrospective cohort study using the nationwide electronic medical records (EMR) database. Patients with the diagnosis of MS were extracted from inpatient and outpatient EMR using the international classification of diseases, ninth/tenth revisions, clinical modification codes. We excluded patients younger than 18 years, and those where gender was not specified. Patients were further stratified based on their demographics, risk factors, medications, and comorbidities. Tobacco, diabetes, hypertension, and alcohol were the predicting variables; antiplatelet medication, and anticoagulant agents were the primary exposures for the development of ICH. A validated diagnosis code algorithm defined the diagnosis of ICH. Multivariable logistic regression models were utilized to assess the risk of ICH in MS patients. RESULTS: Of the total 57,099 MS patients (women: 75%, n = 41,517), 107 (.19%) sustained an ICH. Age (OR = 2.74, CI = 1.13-6.62), use of anticoagulants (OR = 2.15, 95% CI = 1.30-3.56, P = .0028), and history of tobacco exposure (OR = 2.44, CI = 1.37-4.36, P = .0025) were associated with increased risk of ICH. Use of antiplatelet and disease-modifying drugs (DMDs) showed a protective trend against ICH. CONCLUSIONS: Tobacco exposure and anticoagulant use were strongly associated with increased risk of ICH in patients with MS. There might be a protective effect that antiplatelet and DMDs have in the pathophysiology of this disease. Further prospective investigations are warranted to establish these associations.

Development of new PTK7-targeting aptamer-fluorescent and -radiolabelled probes for evaluation as molecular imaging agents: Lymphoma and melanoma in vivo proof of concept.

Aptamers are single-stranded oligonucleotides that recognize molecular targets with high affinity and specificity. Aptamer that selectively bind to the protein tyrosine kinase-7 (PTK7) receptor, overexpressed on many cancers, has been labelled as probes for molecular imaging of cancer. Two new PTK7-targeting aptamer probes were developed by coupling frameworks from the fluorescent dye AlexaFluor647 or the 6-hydrazinonicotinamide (HYNIC) chelator-labelled to 99mTc. The derivatizations via a 5'-aminohexyl terminal linker were done at room temperature and under mild buffer conditions. Physicochemical and biological controls for both imaging agents were performed verifying the integrity of the aptamer-conjugates by HPLC. Recognition of melanoma (B16F1) and lymphoma (A20) mouse cell lines by the aptamer was studied using cell binding, flow cytometry and confocal microscopy. Finally, in vivo imaging studies in tumour-bearing mice were performed. The new probes were able to bind to melanoma and lymphoma cell lines in vitro, the in vivo imaging in tumour-bearing mice showed different uptake behaviours showing for the fluorescent conjugate good uptake by B cell lymphoma while the radiolabelled conjugate did not display tumour uptake due to its high extravascular distribution, and both showed rapid clearance properties in tumour-bearing mice.

Metastatic Hepatoblastoma in Adolescence: A Clinical Case Report and Literature Review.

Hepatoblastoma is the most common hepatic neoplasm in children. However, its incidence is infrequent beyond age five. We present the case of a 15-year-old female diagnosed with metastatic hepatoblastoma during hospitalization for liver function deterioration. The patient presented with abdominal distension, jaundice, and other symptoms indicative of advanced disease. Imaging and biopsy confirmed stage IV epithelial hepatoblastoma with pulmonary metastases. This case underscores the importance of considering hepatoblastoma in older pediatric patients or young adults presenting with hepatic masses despite lacking traditional risk factors for liver malignancies.

Mechanical energy on anaerobic capacity during a supramaximal treadmill running in men: Is there influence between runners and active individuals?

This study verified whether mechanical variables influence the anaerobic capacity outcome on treadmill running and whether these likely influences were dependent of running experience. Seventeen physical active and 18 amateur runners, males, performed a graded exercise test and constant load exhaustive running efforts at 115% of intensity associated to maximal oxygen consumption. During the constant load were determined the metabolic responses (i.e., gas exchange and blood lactate) to estimate the energetic contribution and anaerobic capacity as well as kinematic responses. The runners showed higher anaerobic capacity (16.6%; p = 0.005), but lesser time to exercise failure (-18.8%; p = 0.03) than active subjects. In addition, the stride length (21.4%; p = 0.00001), contact phase duration (-11.3%; p = 0.005), and vertical work (-29.9%; p = 0.015). For actives, the anaerobic capacity did not correlate significantly with any physiologic, kinematic, and mechanical variables and no regression model was fitted using the stepwise multiple regression, while to runners the anaerobic capacity was significantly correlated with phosphagen energetic contribution (r = 0.47; p = 0.047), external power (r = -0.51; p = 0.031), total work (r = -0.54; p = 0.020), external work (r = -0.62; p = 0.006), vertical work (r = -0.63; p = 0.008), and horizontal work (r = -0.61; p = 0.008), and the vertical work and phosphagen energetic contribution presented a coefficient of determination of 62% (p = 0.001). Based on findings, it is possible to assume that for active subjects, the mechanical variables have no influence over the anaerobic capacity, however, for experienced runners, the vertical work and phosphagen energetic contribution have relevant effect over anaerobic capacity output.

Characterization of Three Different Mediterranean Beef Fattening Systems: Performance, Behavior, and Carcass and Meat Quality.

The aim of this study was to characterize three different commercial dairy beef fattening systems for intensive Mediterranean fattening programs differing in gender, breed, nutrition, and days of feed in order to describe their performance, behavior, and carcass and meat quality when they were raised simultaneously under the same housing and care conditions. Treatments were three different production systems: (1) crossbred Holstein x beef breeds such as Charolais or Limousine heifers, slaughtered at 10 months of age (CBH10, n = 41); (2) Holstein bulls, slaughtered at 11 months of age (HB11, n = 42); and (3) crossbred Holstein x Angus bulls, slaughtered at 12 months of age (CAB12, n = 37). According to our results, moving from a production system based on Holstein bulls to the crossbred Angus production system has no technical support as no large production and meat quality improvements were observed, and only marketing strategies for meat differentiation and consumer trends could favor this decision.

Detection of Velogenic Avian Paramyxoviruses in Rock Doves in New York City, New York.

Avian paramyxovirus 1 (APMV-1), also known as Newcastle disease virus (NDV), causes severe and economically important disease in poultry around the globe. Although a limited amount of APMV-1 strains in urban areas have been characterized, the role of the urban wild bird population as an APMV-1 reservoir is unclear. Because urban birds may have an important role for long-term circulation of the virus, fecal and swab samples were collected by community scientists from wild birds in New York City (NYC), New York, United States. These samples were screened for APMV-1 and genotypically characterized by sequencing of the complete genome. A total of 885 samples were collected from NYC parks and from a local wildlife rehabilitation clinic from October 2020 through June 2021, and 255 samples obtained from 197 birds have been processed to date. Eight birds (4.1%) screened positive for the APMV-1 nucleoprotein gene by conventional reverse transcription PCR (RT-PCR), and two live viruses were isolated via egg culture. A multibasic F protein cleavage sequence, 112R R K K R F117, an indicator of highly pathogenic velogenic APMV-1 strains, was present in the two samples fully sequenced by next generation sequencing. Phylogenetic analysis of the F gene coding sequence classified both isolates into genotype VI, a diverse and predominant genotype responsible for APMV-1 outbreaks in pigeon and dove species worldwide. IMPORTANCE Here we describe the first large-scale effort to screen for APMV-1 in New York City's wild bird population as part of the New York City Virus Hunters program, a community science initiative. We characterized two isolates of APMV-1, with phylogenetic analyses suggesting diversity in established and circulating strains of pigeon paramyxoviruses. Our isolates are also domestic reference strains for future APMV-1 vaccine developments. Future surveillance in this region may contribute to our understanding of APMV-1's evolution and genetic diversity, as well as inform poultry husbandry and vaccination practices in New York State.

DarkCideS 1.0, a global database for bats in karsts and caves.

Understanding biodiversity patterns as well as drivers of population declines, and range losses provides crucial baselines for monitoring and conservation. However, the information needed to evaluate such trends remains unstandardised and sparsely available for many taxonomic groups and habitats, including the cave-dwelling bats and cave ecosystems. We developed the DarkCideS 1.0 ( https://darkcides.org/ ), a global database of bat caves and species synthesised from publicly available information and datasets. The DarkCideS 1.0 is by far the largest database for cave-dwelling bats, which contains information for geographical location, ecological status, species traits, and parasites and hyperparasites for 679 bat species are known to occur in caves or use caves in part of their life histories. The database currently contains 6746 georeferenced occurrences for 402 cave-dwelling bat species from 2002 cave sites in 46 countries and 12 terrestrial biomes. The database has been developed to be collaborative and open-access, allowing continuous data-sharing among the community of bat researchers and conservation biologists to advance bat research and comparative monitoring and prioritisation for conservation.

To Provide a Double Feeder in Growing Pigs Housed under High Environmental Temperatures Reduces Social Interactions but Does Not Improve Weight Gains.

Heat stress and competition for food are two major challenges in pigs reared in intensive conditions. The aim of the present work was to study the effect of providing a double feeder for pigs reared under two different environmental temperatures. In addition, two types of flooring, of 100% slat and 30% slat 70% concrete, were also considered. A total of 256 pigs in the growing-finishing period (from 27 kg to 110 kg) were housed using two environmental temperatures: control (from 18 °C to 25 °C) and heat stress (above 30 °C six hours a day). They were housed in 32 pens of 8 pigs each, distributed into 4 rooms (16 with one feeder and 16 with two). Pigs subjected to temperatures above 30 °C up to six hours had lower body weight gains than pigs subjected to a maximum temperature of 25 °C, confirming that thermal stress negatively affects performance in pigs. In addition, heat stress affected the final product by decreasing the lean percentage of carcasses by 2.6%. A double feeder reduced the presence of negative social behavior, especially in the feeding area, but body weight was lower than when one single feeder was used. A 30% slat 70% concrete floor showed better results in the pig stress indicators and body weights than 100% slat. It is concluded that providing a double feeder in the pens, although reducing the presence of negative social interactions, negatively affected body weight, in comparison to pigs fed with just one feeder.

The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort.

PURPOSE: To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. METHODS: This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women without PCOS who had a delivered pregnancy within Kaiser Permanente Northern California. Preexisting hypertension was defined by hypertension diagnosis, treatment, or elevated blood pressure prior to 20 weeks of gestation. The development of PIH, including gestational hypertension, preeclampsia/eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count), was ascertained by chart review. Among women without preexisting hypertension who had a singleton pregnancy, the association of PCOS and PIH was examined using multivariable logistic regression. RESULTS: Among 1902 women (910 PCOS) with singleton pregnancy, 101 (11.1%) PCOS and 36 (3.6%) non-PCOS women had preexisting hypertension and were excluded. Of the remaining 1765 women, those with PCOS (compared to non-PCOS) were slightly older (mean age 31.2 versus 30.7), more likely to be obese (39.6% versus 15.1%), nulliparous (63.8% versus 43.4%), and conceive with fertility treatment (54.1% versus 1.9%); they also had a higher incidence of PIH (10.8% versus 6.6%), including gestational hypertension (5.8% versus 3.6%) and preeclampsia or HELLP (4.9% versus 3.0%; all p<0.05). PCOS was associated with increased odds of PIH (odds ratio, OR 1.7, 95% confidence interval, CI 1.2-2.4), remaining significant after adjusting for age, race/ethnicity, nulliparity, and fertility treatment; however, findings were attenuated and no longer significant after adjusting for weight status (OR 1.1, CI 0.7-1.7). Maternal PCOS was also associated with preeclampsia/HELLP in unadjusted but not adjusted (OR 1.0, CI 0.5-1.9) analyses. Nulliparity and higher prepregnancy BMI were associated with PIH in both groups. CONCLUSION: Compared to women without PCOS, women with PCOS are at higher risk for PIH but this association was not independent of weight status.

Design and development of 6-hydrazinonicotinyl-fatty acid-mimetic 99mTc-complex as a potential myocardial imaging agent

Abstract The goal of this work is to identify new fatty acid-mimetic 99mTc-complexes to be used as myocardial imaging agents that allow studying heart abnormalities in high-risk patients. In this sense, we designed a fatty acid-mimetic substructure including an amide moiety that, among other properties, could improve myocardial residence time. A diamide with a chain length of 15 atoms and porting a 6-hydrazinonicotinyl (HYNIC) chelator, and an analog with a short carbon-chain, were prepared with convergent organic synthetic procedures and radiolabeled with 99mTc using tricine as the sole coligand. The in vivo proofs of concept were performed using healthy mice. The new 99mTc-complexes were obtained with adequate radiochemical purity. The lipophilicities were in agreement with the length of the chains. While both 99mTc-complexes showed uptake in the myocardial muscle, the designed radiopharmaceutical with the longest chain length had preferential target-uptake and target-retention compared to other complexes described in the bibliography. Further studies, involving imaging assays, synthetic modifications, and assay of new coligands for 99mTc-HYNIC complexes, are currently ongoing.

3-min all-out effort on cycle ergometer is valid to estimate the anaerobic capacity by measurement of blood lactate and excess post-exercise oxygen consumption.

The purpose of this study was to investigate the use of a single 3-min all-out maximal effort to estimate anaerobic capacity (AC) through the lactate and excess post-exercise oxygen consumption (EPOC) response methods (AC[La-]+EPOCfast) on a cycle ergometer. Eleven physically active men (age = 28.1 ± 4.0 yrs, height = 175.1 ± 4.2 cm, body mass = 74.8 ± 11.9 kg and ⩒O2max = 40.7 ± 7.3 mL kg-1 min-1), participated in the study and performed: i) five submaximal efforts, ii) a supramaximal effort at 115% of intensity of ⩒O2max, and iii) a 3-min all-out maximal effort. Anaerobic capacity was estimated using the supramaximal effort through conventional maximal accumulated oxygen deficit (MAOD) and also through the sum of oxygen equivalents from the glycolytic (fast component of excess post-exercise oxygen consumption) and phosphagen pathways (blood lactate accumulation) (AC[La-]+EPOCfast), while during the 3-min all-out maximal effort the anaerobic capacity was estimated using the AC[La-]+EPOCfast procedure. There were no significant differences between the three methods (p > 0.05). Additionally, the anaerobic capacity estimated during the 3-min all-out effort was significantly correlated with the MAOD (r = 0.74; p = 0.009) and AC[La-]+EPOCfast methods (r = 0.65; p = 0.029). Therefore, it is possible to conclude that the 3-min all-out effort is valid to estimate anaerobic capacity in physically active men during a single cycle ergometer effort.

MRI-Guided High-Intensity Focused Ultrasound as an Emerging Therapy for Stroke: A Review.

Stroke, either ischemic or hemorrhagic, accounts for significantly high morbidity and mortality rates around the globe effecting millions of lives annually. For the past few decades, ultrasound has been extensively investigated to promote clot lysis for the treatment of stroke, myocardial infarction, and acute peripheral arterial occlusions, with or without the use of tPA or contrast agents. In the age of modern minimal invasive techniques, magnetic resonance imaging-guided high-intensity focused ultrasound is a new emerging modality that seems to promise therapeutic utilities for both ischemic and hemorrhagic stroke. High-intensity focused ultrasound causes thermal heating as the tissue absorbs the mechanical energy transmitted by the ultrasonic waves leading to tissue denaturation and coagulation. Several in-vitro and in-vivo studies have demonstrated the viability of this technology for sonothrombolysis in both types of stroke and have warranted clinical trials. Apart from safety and efficacy, initiation of trials would further enable answers regarding its practical application in a clinical setup. Though this technology has been under study for treatment of various brain diseases for some decades now, relatively very few neurologists and even neurosurgeons seem to be acquainted with it. The aim of this review is to provide basic understanding of this powerful technology and discuss its clinical application and potential role as an emerging viable therapeutic option for the future management of stroke.

Effect of sex and RYR1 gene mutation on the muscle proteomic profile and main physiological biomarkers in pigs at slaughter.

Gender and RYR1 gene mutation might have an effect on the muscle metabolic characteristics and on the animal's stress at slaughter, which could influence the process of muscle-to-meat conversion. Forty-eight pigs were distributed in a design including two factors: sex (male/female) and RYR1 genotype (NN/Nn). At slaughter, physiological blood biomarkers and muscle proteome were analyzed and carcass and meat quality traits were registered. Females had higher serum levels of glucose, urea, C-reactive protein "CRP", Pig-MAP and glutation-peroxidase "GPx" and lower levels of lactate, showed faster muscle pH decline and higher meat exudation. RYR1 mutation increased serum creatinine, creatine kinase and CRP and decreased GPx. The proteomic study highlighted significant effects of gender and RYR1 genotype on proteins related to fibre composition, antioxidant defense and post mortem glycolytic pathway, which correlate to differences of meat quality. This study provides interesting information on muscle biomarkers of the ultimate meat quality that are modulated by the animal's individual susceptibility to stress at slaughter.

Racial and ethnic differences in hip fracture outcomes in men.

OBJECTIVES: To examine temporal trends and racial/ethnic differences in hip fracture incidence and mortality outcome in older men. STUDY DESIGN: Retrospective cohort study. METHODS: We ascertained men 50 years or older with a hip fracture during 2000 to 2010 in a diverse northern California healthcare population. Age, comorbidity index, hip fracture incidence, and all-cause mortality up to 12 months post fracture were examined and compared by race/ethnicity. RESULTS: A total of 6247 men (aged 79.3 ± 9.8 years) experienced a hip fracture during 2000 to 2010: 81.4% were white, 7.5% Hispanic, 3.8% black, and 3.9% Asian. The age-adjusted annual incidence of hip fracture averaged 127 per 100,000, ranging from 116 to 139 per 100,000 during this period. In 2010, the age-adjusted incidence of hip fracture was highest among white men (137), followed by Hispanic (98) and black (80), and was lowest among Asian men (45 per 100,000). Mortality following hip fracture was 11.1%, 19.8%, 25.4%, and 32.9%, within 1, 3, 6, and 12 months, respectively, and increased with age. One-year mortality was similar for whites (33.7%), blacks (32.4%), and Hispanics (31.1%), but lower for Asians (23.1%; P <.05). Adjusting for age, comorbidity index, and calendar year, Asians remained at lower mortality risk compared with whites (adjusted odds ratio, 0.62; 95% confidence interval, 0.45-0.86). CONCLUSIONS: Although hip fracture rates were largely stable among older men, contemporary rates of hip fracture were highest for white and lowest for Asian men. One-year mortality was similar for white, black, and Hispanic men, but significantly lower for Asians. Future studies should investigate factors underlying observed ethnic differences in fracture outcome among US men.

Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women with Polycystic Ovary Syndrome.

BACKGROUND: This study examines gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS) and the risk of type 2 diabetes mellitus (DM) following GDM pregnancy. METHODS: A cohort of 988 pregnant women with PCOS who delivered during 2002-2005 was examined to determine the prevalence and predictors of GDM, with follow-up through 2010 among those with GDM to estimate the risk of DM. RESULTS: Of the 988 pregnant women with PCOS, 192 (19%) developed GDM. Multivariable predictors of GDM included older age, Asian race, prepregnancy obesity, family history of DM, preconception metformin use, and multiple gestation. Among women with PCOS and GDM pregnancy, the incidence of DM was 2.8 (95% confidence interval (CI) 1.9-4.2) per 100 person-years and substantially higher for those who received pharmacologic treatment for GDM (6.6 versus 1.5 per 100 person-years, p < 0.01). The multivariable adjusted risk of DM was fourfold higher in women who received pharmacologic treatment for GDM (adjusted hazard ratio 4.1, 95% CI 1.8-9.6). The five-year incidence of DM was 13.1% overall and also higher in the pharmacologic treatment subgroup (27.0% versus 7.1%, p < 0.01). CONCLUSIONS: The strongest predictors of GDM among women with PCOS included Asian race and prepregnancy obesity. Pharmacologic treatment of GDM is associated with fourfold higher risk of subsequent DM.

Antropología Física en función de las ciencias médicas: una necesidad de estos tiempos / Physical anthropology for medical sciences: a need in current times

Introducción: El sistema de conocimientos de Antropología Física responde a especialidades médicas como la Anatomía Humana y la Medicina Legal. En Cuba estas especialidades médicas no cuentan con la profundidad y superación profesional adecuada que permita el uso práctico de estos conocimientos. Objetivo: Caracterizar el entrenamiento de posgrado "Osteología y Odontología en función de la identificación humana", realizado en la Universidad de Ciencias Médicas de Matanzas entre enero y marzo de 2020. Métodos: Estudio observacional, descriptivo y de corte transversal. La población estuvo compuesta por 25 cursistas, especialistas en Medicina Legal y Anatomía Humana. Se consideraron variables como programa de estudio, categoría docente de los participantes, satisfacción con su desarrollo y resultados de la promoción docente. Para las indagaciones empíricas se aplicó la técnica de PNI como parte de la valoración general del curso. Resultados: El curso se impartió durante 56 horas en 7 semanas. Como parte de sus logros se realizó la clasificación y caracterización antropológica de una parte de la osamenta de la Osteoteca de la Universidad de Ciencias Médicas de Matanzas, así como la ampliación de esta mediante una sección de Antropología Física que incorporó seis cadáveres completos caracterizados antropológicamente. Conclusiones: Este entrenamiento permitió adiestrar y actualizar a los cursistas sobre la identificación humana, a partir del estudio de los restos óseos referentes a la expresión cualitativa y cuantitativa de los caracteres morfológicos, que responden a las necesidades de la práctica docente en anatomía y la asistencia médico legal(AU)

Introduction: The knowledge system of Physical Anthropology responds to medical specialties such as Human Anatomy and Legal Medicine. In Cuba, these medical specialties do not have adequate depth and professional improvement that allows the practical use of this knowledge. Objective: To characterize the training about osteology and dental medicine in view of human identification, carried out at the University of Medical Sciences of Matanzas between January and March 2020. Methods: Observational, descriptive and cross-sectional study. The population consisted of 25 trainees, specialists in Legal Medicine and Human Anatomy. Some variables were considered, such as study program, teaching category of the participants, satisfaction with their development and results of teaching promotion. For the empirical inquiries, the positive-negative-interesting technique was applied as part of the general assessment of the course. Results: The course lasted 56 hours distributed in seven weeks. As part of its achievements, the anthropological classification and characterization of a part of the materials from the bone collection of the University of Medical Sciences of Matanzas was carried out, as well as its expansion through a physical anthropology section that incorporated six complete corpses anthropologically characterized. Conclusions: This training allowed to train and update the students on human identification, based on the study of bone remains referring to the qualitative and quantitative expression of morphological characters, which respond to the needs of teaching practice in Anatomy, as well as in legal-medical assistance(AU)

The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy.

PURPOSE: Several epidemiologic studies suggest that compared to white women, Asians have a greater propensity to suffer an atypical femur fracture (AFF) while taking bisphosphonate therapy. This study examines the relative risk of AFF following bisphosphonate initiation for Asian compared to white women. METHODS: Using data from a large integrated northern California healthcare delivery system, we examined diaphyseal femur fracture outcomes among women age≥50years old who initiated oral bisphosphonate therapy during 2002-2007. An AFF was defined by the 2013 American Society of Bone and Mineral Research Task Force criteria. The risk of radiographically-confirmed AFF was examined for Asian compared to white women, adjusting for differences in bisphosphonate exposure and other potential risk factors. RESULTS: Among 48,390 women (65.3% white, 17.1% Asian) who newly initiated bisphosphonate therapy and were followed for a median of 7.7years, 68 women experienced an AFF. The rate of AFF was 18.7 per 100,000 person-years overall and eight-fold higher among Asian compared to white women (64.2 versus 7.6 per 100,000 person-years). Asians were also more likely to have longer bisphosphonate treatment duration compared to whites (median 3.8 versus 2.7years). The age-adjusted relative hazard for AFF was 8.5 (95% confidence interval 4.9-14.9) comparing Asian to white women, and was only modestly reduced to 6.6 (3.7-11.5) after adjusting for bisphosphonate duration and current use. CONCLUSIONS: Our study confirms marked racial disparity in AFF risk that should be further investigated, particularly the mechanisms accounting for this difference. These findings also underscore the need to further examine the association of bisphosphonate duration and AFF in women of Asian race, as well as differential risk across Asian subgroups. In the interim, counseling of Asian women about osteoporosis drug continuation should include consideration of their potentially higher AFF risk.

Gestational thyrotoxicosis, antithyroid drug use and neonatal outcomes within an integrated healthcare delivery system.

BACKGROUND: Increasing attention has focused on the prevalence and outcomes of hyperthyroidism in pregnancy, given concerns for hepatotoxicity and embryopathy associated with antithyroid drugs (ATDs). METHODS: In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD use (propylthiouracil [PTU] or methimazole [MMI]) in women with delivered pregnancies from 1996 to 2010. Birth outcomes were compared among all infants and those born to mothers with diagnosed thyrotoxicosis or ATD therapy during gestation, with examination of ATD-associated hepatotoxicity and congenital malformations in the latter subgroups. RESULTS: Among 453,586 mother-infant pairs (maternal age 29.7±6.0 years, 57.1% nonwhite), 3.77 per 1000 women had diagnosed thyrotoxicosis and 1.29 per 1000 had gestational ATD exposure (86.5% PTU, 5.1% MMI, 8.4% both). Maternal PTU-associated hepatotoxicity occurred with a frequency of 1.80 per 1000 pregnancies. Infants of mothers with diagnosed thyrotoxicosis (odds ratio [OR] 1.28, 95% confidence interval [CI 1.05-1.55]) or gestational ATD use (OR 1.31 [1.00-1.72]) had an increased risk of preterm birth compared to those born to mothers without thyrotoxicosis or ATD. The risk of neonatal intensive care unit (NICU) admission was also higher with maternal thyrotoxicosis (OR 1.30 [1.07-1.59]) and ATD exposure (OR 1.64 [CI 1.26-2.13]), adjusting for prematurity. Congenital malformation rates were low and similar among infants born to mothers with thyrotoxicosis or ATD exposure (30-44 per 1000 infants). CONCLUSIONS: Gestational ATD exposure occurred in 1.29 per 1000 mother-infant pairs while a much larger number had maternal diagnosed thyrotoxicosis but no drug exposure during pregnancy. Infants of mothers with gestational ATD use or diagnosed thyrotoxicosis were more likely to be preterm and admitted to the NICU. The rates of congenital malformation were low for mothers diagnosed with thyrotoxicosis and did not differ by ATD use. Among women with gestational PTU therapy, the frequency of PTU-associated hepatotoxicity was 1.8 per 1000 delivered pregnancies. These findings from a large, population-based cohort provide generalizable estimates of maternal and infant risks associated with maternal thyrotoxicosis and related pharmacotherapy.