Health state utility values and patient-reported outcomes before and after vertebral and non-vertebral fractures in an osteoporosis clinical trial.

We assessed the health state utility value (HSUV) reductions associated with vertebral fractures using data collected in the Japanese Osteoporosis Intervention Trial-03 (JOINT-03). Our analysis revealed that assessment of HSUVs after morphometric vertebral fracture is important to capture the burden of vertebral fractures. INTRODUCTION: Evaluation of the HSUV after fracture is important to calculate the quality-adjusted life years (QALYs) of osteoporosis patients, which is essential information in the context of health economic evaluation. METHODS: JOINT-03 study patients were aged ≥65 years and treated with risedronate and vitamin K2 or risedronate alone. Radiographic information and patient-reported outcomes measured by EQ-5D and a visual analogue scale (VAS) were assessed at registration and followed up after 6, 12, and 24 months. According to differences among the dates of these assessments and the radiographic information, we classified the follow-up HSUVs calculated based on EQ-5D results into before or after fracture categories regardless of clinical symptoms. RESULTS: Among 2922 follow-up HSUVs, 201 HSUVs were categorized as HSUVs that were observed after incident vertebral fractures on X-ray films. The median time from the detection of an incident vertebral fracture until the EQ-5D assessment was 53 days (25th percentile, 0 day; 75th percentile, 357 days). The impact of incident vertebral fractures on HSUVs was quantified as -0.03. Among the five health profile domains on the EQ-5D, an incident vertebral fracture had significant effects on anxiety/depression, self-care, and usual activities. CONCLUSIONS: The results suggest that incident morphometric vertebral fracture was associated with impairment of the HSUV for patients with osteoporosis not only immediately but also several months after the fracture.

An experimental attenuation plate to improve the dose distribution in intraoperative electron beam radiotherapy for breast cancer.

Intraoperative electron beam radiotherapy (IOERT) is a technique in which a single-fraction high dose is intraoperatively delivered to subclinical tumour cells using an electron beam after breast-conserving surgery. In IOERT, an attenuation plate consisting of a pair of metal disks is commonly used to protect the normal tissues posterior to the breast. However, the dose in front of the plate is affected by backscatter, resulting in an unpredictable delivered dose to the tumour cells. In this study, an experimental attenuation plate, termed a shielding plate, was designed using Monte Carlo simulation, which significantly diminished the electron beam without introducing any backscatter radiation. The plate's performance was verified by measurements. It was made of two layers, a first layer (source side) of polymethyl methacrylate (PMMA) and a second layer of copper, which was selected from among other metals (aluminium, copper and lead) after testing for shielding capability and the range and magnitude of backscatter. The optimal thicknesses of the PMMA (0.71 cm) and copper (0.3 cm) layers were determined by changing their thicknesses during simulations. On the basis of these results, a shielding plate was prototyped and depth doses with and without the plate were measured by radiophotoluminescence glass dosimeters using a conventional stationary linear accelerator and a mobile linear accelerator dedicated for IOERT. The trial shielding plate functioned as intended, indicating its applicability in clinical practice.

[Reality of psychotherapeutic care with regard to outpatient psychotherapy of elderly people in Münsterland (Westfalia)]. / Versorgungssituation älterer Menschen hinsichtlich ambulanter Richtlinien-Psychotherapie.

The need for efficacy of geriatric psychotherapy as well specialized training in geriatric psychosomatics and psychotherapy is commonly recognized amongst professionals. Despite this, this knowledge is not reflected in everyday life. One consequence of this is that psychotherapy for elderly patients is still the exception. We conducted a study in which 478 practicing psychotherapists in Münsterland (Westfalia) were surveyed by mail questionnaire regarding the number and main diagnosis of their patients of greater than 50 years of age, as well as the elderly-specific therapies or future plans for such therapies they might have. The response rate was 65% (312 psychotherapists who answered the questionnaire). The results showed that patients older than 60 years of age were greatly underrepresented compared to younger patients. Moreover, specific therapies, such as age-specific psychotherapy in groups, were rare. To date, it seems that only a minority of elderly patients with psychiatric and psychosomatic diseases are treated adequately by psychotherapy in the outpatient sector. This was evident even in a region such as Münsterland, which has plentiful psychotherapeutic resources.

Enhancement of oxygen transfer efficiency in diffused aeration systems using liquid-film-forming apparatus.

Surface transfer and bubble transfer both contribute significantly to oxygen transfer in a diffused aeration system. In the present study, liquid-film-forming apparatus is successfully developed on a laboratory scale to improve considerably the surface transfer via the unique liquid film transfer technique. The experimental results show that the volumetric mass transfer coefficient for liquid-film-forming apparatus alone is found to be as much as 5.3 times higher than that for water surface and that the total volumetric mass transfer coefficient for liquid film aeration system increases by 37 % in comparison with conventional aeration system. Additionally, by tuning finely the structural parameters of the liquid-film-forming apparatus, it can also lead to high dissolved oxygen water with the dissolved oxygen percent saturation greater than 90 %. More importantly, this result is accomplished by simply offering a single-pass aeration at the depth as shallow as 26 cm. As a result, the objective of economical energy consumption in diffused aeration systems can be realized by lowering the aeration depth without sacrificing the aeration efficiency.

Compost stability assessment using a secondary metabolite: geosmin.

Composting is a process involved not only in transformation of organic matter (OM), but also for transition of the microbial community. Microorganisms can directly provide important information on the stages and characteristics of composting. This paper was aimed at characterizing compost stability by a microbial secondary metabolite, geosmin, which is a volatile compound presenting an earthy smell. Since secondary metabolite production is dependent on the nutrient state of microorganisms, its production in association with physical and chemical parameters was monitored in the laboratory-scale and plant-scale composting processes. The results showed that the peaked geosmin liberation was consistent with stable state of composting indicated by the ambient temperature achieved, a slightly alkaline product and steady states of dissolved organic carbon (DOC), N and P contents and OM degradation in the laboratory-scale experiment. It was also in accordance with the stability identified by the facilities and CO2 respiration rate in the plant-scale composting. In addition, the production of geosmin was correlated with the C/N ratio for the solid sample. These results demonstrated that geosmin levels could be used as an index for the compost stability assessment in different composting processes with various organic solid wastes.

Functional and perfusional assessment with electrocardiograph-gated single photon emission computed tomography after minimally invasive direct coronary artery bypass grafting.

BACKGROUND: Because of limited surgical field, minimally invasive coronary artery bypass grafting (MIDCAB) requires anastomosis to the distal portion of the left anterior descending artery (LAD) of the left internal thoracic artery (LITA) with the heart beating. Though the diameters of these arteries are very small, it is unknown whether blood flow sufficient for the LAD territory is obtained by bypass grafting. METHOD: Eight patients with single-vessel disease of the LAD underwent MIDCAB with the LITA to the LAD and we evaluate the perfusion and function in the LAD territory by quantitative ECG-gated SPECT (QGS) with 99m-technetium sestamibi (MIBI) before and after operation. RESULT: The intraoperatively measured diameters of the LITA and LAD at the site of anastomosis were 1.1+/-0.2 mm and 1.3+/-0.4 mm, respectively. The percentage increases in end-diastolic perfusion, regional ejection fraction and regional wall thickening in the anteroseptal area after MIDCAB were 136.3+/-11.7(p=0.071), 148.4+/-6.6(p=0.007) and 133.0+/-5.6(p=0.029), respectively (paired t-test, mean +/- SD %). Stress-rest MIBI SPECT indicated no ischemia in anteroseptal wall. CONCLUSION: The MIDCAB technique thus appeared to improve perfusion and function in the LAD territory despite bypass to the distal LAD, and ECG-gated MIBI SPECT using QGS software was very useful for evaluating the quality of anastomosis after MIDCAB.

Effects of absorption enhancers on the transport of model compounds in Caco-2 cell monolayers: assessment by confocal laser scanning microscopy.

Three typical absorption enhancers, i.e., sodium caprate (Cap-Na), sodium deoxycholate (Deo-Na), and dipotassium glycyrrhizinate (Grz-K), were compared in terms of their permeability-enhancing effects on hydrophilic and hydrophobic model compounds in Caco-2 cell monolayers. The transepithelial electrical resistance (TEER) of the monolayers was reduced concentration-dependently by treatment with Cap-Na and Deo-Na, while treatment with Grz-K increased the TEER. Two patterns of TEER reduction were observed: one pattern indicated that Cap-Na had a rapid reducing effect, and another indicated that Deo-Na had a delayed reducing effect. These reductions in the TEER were accompanied by the increased transepithelial transport of two hydrophilic model compounds, sodium fluorescein (Flu-Na; MW = 376, log P = -1.52) and fluorescein isothiocyanate-dextran 4000 (FD-4; MW = 4400, log P = -2.0), and one hydrophobic model compound, rhodamine 123 hydrate (Rh123; MW = 381, log P = 1.13). The transport-enhancing effects of Cap-Na and Deo-Na on these model compounds decreased in the following order: FD-4 > Rh123 > Flu-Na, while Grz-K was found to have no effect on the transport of any of these model compounds. Confocal laser scanning microscopy (CLSM) of Caco-2 cell monolayers revealed that Cap-Na and Deo-Na enhanced the transepithelial transport of the hydrophilic model compounds via the paracellular route and that of the hydrophobic model compound via both paracellular and transcellular routes. Semiquantitative visual information obtained from CLSM images reflected the results of the transport experiment.

Assessment of rate of O2 release from single hepatic sinusoids of rats.

Characteristics of O2 release from single hepatic sinusoids are described in relation to the sinusoidal O2 inflow for the first time. Microspectroscopic measurement of the rate of O2 release (RO2) from single sinusoids to surrounding hepatocytes was carried out at the edge of the liver of anesthetized rats. The oxyhemoglobin inflow ([HbO2] inflow) into sinusoids, which is a product of sinusoidal blood flow rate and inflowing oxyhemoglobin concentration ([HbO2]), was varied by exchange transfusion of blood with physiological saline. 1) RO2 from single hepatic sinusoids of control rats was fairly constant [0.66 +/- 0.14 (SD) nmol.cm-2.s-1, with 18 sinusoids of 9 rats] over a wide range of [HbO2] inflow (50-200 fmol/s). 2) In the cases of mild anemia, [HbO2] inflow scarcely decreased but RO2 increased, probably because of the increased metabolism of hepatocytes. 3) In the cases of severe anemia, [HbO2] inflow decreased below 50 fmol/s and RO2 decreased accordingly. 4) In all cases no difference was observed between the RO2 values obtained from periportal zone and those from pericentral zone. These results are discussed on the bases of the vascular structure and function of hepatic sinusoids and on the animal model of hemorrhagic shock.