Correlación entre la incidencia de lesión del manguito rotador en luxación glenohumeral anterior traumática y el hombro contralateral / Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder

Introducción: En el contexto de la luxación glenohumeral anterior, en los pacientes mayores de 60 años, el manguito rotador posterosuperior es más susceptible a lesionarse debido a su condición degenerativa preexistente. Sin embargo, en este grupo etario, la evidencia científica no logra dilucidar si las lesiones del manguito rotador son causa o consecuencia de la inestabilidad recurrente de hombro. El objetivo de este trabajo es describir la prevalencia de lesiones del manguito rotador en una serie de hombros consecutivos en mayores de 60 años que sufrieron un primer episodio de luxación glenohumeral traumática, y su correlación con lesiones del manguito rotador en el hombro contralateral. Métodos: Se estudiaron de forma retrospectiva 35 pacientes mayores de 60 años que presentaron un primer episodio de luxación glenohumeral anterior traumática unilateral y que contaban con RMN de ambos hombros, determinando la correlación lesional del manguito rotador y de la porción larga del bíceps entre el hombro que sufrió el evento traumático y el contralateral, presumiblemente sano. Resultados: Al valorar la existencia de lesión parcial o completa de los tendones supraespinoso e infraespinoso, la concordancia en el lado afectado y sano, hemos evidenciado resultados concordantes en ambos lados en el 88,6 y 85,7%, respectivamente. El coeficiente de concordancia kappa resultó 0,72 para la lesión del tendón supraespinoso y para la lesión del tendón infraespinoso. Del total de 35 casos evaluados, 8 (22,8%) presentaron al menos alguna alteración en el tendón de la porción larga del bíceps en el lado afectado y solo uno (2,9%) en el lado sano, resultando el coeficiente de concordancia kappa 0,18. De los 35 casos evaluados, 9 (25,7%) presentaron al menos alguna retracción en el tendón del músculo subescapular en el lado afectado, mientras que ningún participante evidenció signos de retracción en el tendón de este músculo en el lado sano...(AU)

Introduction: Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. Methods: Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. Results: When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side...(AU)

[Translated article] Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder / Correlación entre la incidencia de lesión del manguito rotador en luxación glenohumeral anterior traumática y el hombro contralateral

Introducción: En el contexto de la luxación glenohumeral anterior, en los pacientes mayores de 60 años, el manguito rotador posterosuperior es más susceptible a lesionarse debido a su condición degenerativa preexistente. Sin embargo, en este grupo etario, la evidencia científica no logra dilucidar si las lesiones del manguito rotador son causa o consecuencia de la inestabilidad recurrente de hombro. El objetivo de este trabajo es describir la prevalencia de lesiones del manguito rotador en una serie de hombros consecutivos en mayores de 60 años que sufrieron un primer episodio de luxación glenohumeral traumática, y su correlación con lesiones del manguito rotador en el hombro contralateral. Métodos: Se estudiaron de forma retrospectiva 35 pacientes mayores de 60 años que presentaron un primer episodio de luxación glenohumeral anterior traumática unilateral y que contaban con RMN de ambos hombros, determinando la correlación lesional del manguito rotador y de la porción larga del bíceps entre el hombro que sufrió el evento traumático y el contralateral, presumiblemente sano. Resultados: Al valorar la existencia de lesión parcial o completa de los tendones supraespinoso e infraespinoso, la concordancia en el lado afectado y sano, hemos evidenciado resultados concordantes en ambos lados en el 88,6 y 85,7%, respectivamente. El coeficiente de concordancia kappa resultó 0,72 para la lesión del tendón supraespinoso y para la lesión del tendón infraespinoso. Del total de 35 casos evaluados, 8 (22,8%) presentaron al menos alguna alteración en el tendón de la porción larga del bíceps en el lado afectado y solo uno (2,9%) en el lado sano, resultando el coeficiente de concordancia kappa 0,18. De los 35 casos evaluados, 9 (25,7%) presentaron al menos alguna retracción en el tendón del músculo subescapular en el lado afectado, mientras que ningún participante evidenció signos de retracción en el tendón de este músculo en el lado sano...(AU)

Introduction: Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. Methods: Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. Results: When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side...(AU)

[Translated article] Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder.

INTRODUCTION: Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. METHODS: Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. RESULTS: When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side. CONCLUSIONS: Our study has found a high correlation of the presence of a postero-superior rotator cuff injury after presenting a glenohumeral dislocation between the shoulder that has suffered the event and the presumably healthy contralateral shoulder. Nevertheless, we have not found this same correlation with subscapularis tendon injury and medial biceps dislocation.

Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder. / Correlación entre la incidencia de lesión del manguito rotador en luxación glenohumeral anterior traumática y el hombro contralateral.

INTRODUCTION: Anterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. METHODS: Retrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. RESULTS: When assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side. CONCLUSIONS: Our study has found a high correlation of the presence of a postero-superior rotator cuff injury after presenting a glenohumeral dislocation between the shoulder that has suffered the event and the presumably healthy contralateral shoulder. Nevertheless, we have not found this same correlation with subscapularis tendon injury and medial biceps dislocation.

Small Airway Disease in Asthma: Why is it so Important?

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Mutation analysis of the spike protein in Italian feline infectious peritonitis virus and feline enteric coronavirus sequences.

Feline coronavirus (FCoV) exists as two different genotypes, FCoV type I and II, each including two biotypes, feline enteric coronavirus (FECV) and feline infectious peritonitis virus (FIPV), the latter being a virulent variant originating from the former virus. Recently, two amino acid substitutions, M1058L and S1060A, within the spike protein have been associated to the FECV/FIPV virulence change. In this study, we have analysed the frequency of detection of such mutations in FIPV and FECV strains circulating in Italian cats and obtained information about their evolutionary relationships with reference isolates. A total of 40 FCoV strains, including 19 strains from effusions or tissue samples of FIP cats and 21 strains from faecal samples of non-FIP cats, were analysed. Mutation M1058L was detected in 16/18 FCoV-I and 1/1 FCoV-II strains associated with FIP, while change S1060A was presented by two FIPV strains. By phylogenetic analysis, FCoV sequences clustered according to the genotype but not according to the biotype, with FECV/FIPV strains recovered from the same animal being closely related. Further studies are needed to better define the genetic signatures associated with the FECV/FIPV virulence shift.

Tratamiento de la inestabilidad femoropatelar objetiva. Resultados a cinco años de seguimiento / Treatment of objective patellar instability. Results after five years of follow-up

Resumen: Objetivo: Presentar los diferentes procedimientos quirúrgicos en el tratamiento de las inestabilidades femoropatelares objetivas, incluyendo la osteotomía de la tuberosidad tibial anterior y la trocleoplastía femoral. Material y métodos: Con un diseño prospectivo con seguimiento a cinco años que incluyó a 21 pacientes (21 rodillas) tratados por luxación rotuliana recidivante entre Marzo de 2010 y Agosto de 2014, tratándose de forma quirúrgica mediante dos técnicas diferentes según el tipo de inestabilidad estructural de base. Para determinarlo, se analizó el índice radiográfico de Caton-Deschamps (para la evaluación de la altura rotuliana) y parámetros tomográficos para valorar el configuración troclear y distancia desde la tuberosidad tibial anterior hasta la tróclea femoral (TT-TG) en la superposición de imágenes en el plano axial. Resultados: Hemos tenido resultados satisfactorios tanto con la transferencia de la tuberosidad tibial anterior como con la trocleoplastía. En ambos procedimientos se realizó una reconstrucción del ligamento patelofemoral medial (LPFM). Conclusiones: La recurrencia de inestabilidad es muy rara después de estos procedimientos y es más probable que ésta resulte de anomalías asociadas no diagnosticadas o subestimadas. Se requiere una planificación precisa preoperatoria para determinar la altura rotuliana, la ubicación de la tuberosidad tibial anterior y la configuración troclear para obtener resultados satisfactorios.

Abstract: Objective: To present the different surgical procedures in the treatment of objective femoropateral instability, including osteotomy of anterior tibial tuberosity and femoral trocleoplasty. Material and methods: With a prospective 5-year follow-up design that included 21 patients (21 knees) treated for relapsing patellar dislocation between March 2010 and August 2014, treated surgically using 2 different techniques depending on the type of basic structural instability. To determine this, the Caton-Deschamps X-Ray Index (for the evaluation of the patellar height) and tomographic parameters were analyzed to assess the troclear configuration and distance from the anterior tibial tuberosity to the femoral trochlea (TT-TG) in the overlapping of images in the axial plane. Results: We have had satisfactory results both with the transfer of the anterior tibial tuberosity and with the trocleoplasty. In both procedures, a reconstruction of the medial patelo-femoral ligament (LPFM) was performed. Conclusion: Recurrence of instability is very rare after these procedures and is more likely to result from undiagnosed or underestimated associated abnormalities. Precise preoperative planning is required to determine the patellar height, location of the anterior tibial tuberosity, and troclear configuration for satisfactory results.

Chronobiology of acute pancreatitis in a single Italian centre.

OBJECTIVE: Seasonal variation may occur in many different diseases hence influencing awareness in clinical practice. This study aimed to establish seasonal variations of acute pancreatitis by using a validated chronobiological analysis. PATIENTS AND METHODS: All cases of acute pancreatitis consecutively observed in fifteen years, i.e., from January 2003 to December 2017, at St. Anna University Hospital of Ferrara, Italy, were included in this study. Accurate statistical and logistic regression analyses were applied to our database. RESULTS: A total number of 1883 consecutive cases of acute pancreatitis were observed. A significant peak was identified in the summer period (p=0.014). Patient stratification, according to age, showed that elderly people had an increased incidence of acute pancreatitis in autumn and summer (being the biliary stone disease the main cause, p=0.011) vs. other seasons (p=0.003). Mortality occurred more prominently in males vs. females, although the latter gender was more prone to acute pancreatitis (p=0.017). CONCLUSIONS: In a single centre of Northern East of Italy, we demonstrated that acute pancreatitis had a clear seasonal variation with a prominent incidence during summer. Various associated factors could contribute to this chronobiological pattern, including gender, age, and biliary stone disease.

[Treatment of objective patellar instability. Results after five years of follow-up]. / Tratamiento de la inestabilidad femoropatelar objetiva. Resultados a cinco años de seguimiento.

OBJECTIVE: To present the different surgical procedures in the treatment of objective femoropateral instability, including osteotomy of anterior tibial tuberosity and femoral trocleoplasty. MATERIAL AND METHODS: With a prospective 5-year follow-up design that included 21 patients (21 knees) treated for relapsing patellar dislocation between March 2010 and August 2014, treated surgically using 2 different techniques depending on the type of basic structural instability. To determine this, the Caton-Deschamps X-Ray Index (for the evaluation of the patellar height) and tomographic parameters were analyzed to assess the troclear configuration and distance from the anterior tibial tuberosity to the femoral trochlea (TT-TG) in the overlapping of images in the axial plane. RESULTS: We have had satisfactory results both with the transfer of the anterior tibial tuberosity and with the trocleoplasty. In both procedures, a reconstruction of the medial patelo-femoral ligament (LPFM) was performed. CONCLUSION: Recurrence of instability is very rare after these procedures and is more likely to result from undiagnosed or underestimated associated abnormalities. Precise preoperative planning is required to determine the patellar height, location of the anterior tibial tuberosity, and troclear configuration for satisfactory results.

OBJETIVO: Presentar los diferentes procedimientos quirúrgicos en el tratamiento de las inestabilidades femoropatelares objetivas, incluyendo la osteotomía de la tuberosidad tibial anterior y la trocleoplastía femoral. MATERIAL Y MÉTODOS: Con un diseño prospectivo con seguimiento a cinco años que incluyó a 21 pacientes (21 rodillas) tratados por luxación rotuliana recidivante entre Marzo de 2010 y Agosto de 2014, tratándose de forma quirúrgica mediante dos técnicas diferentes según el tipo de inestabilidad estructural de base. Para determinarlo, se analizó el índice radiográfico de Caton-Deschamps (para la evaluación de la altura rotuliana) y parámetros tomográficos para valorar el configuración troclear y distancia desde la tuberosidad tibial anterior hasta la tróclea femoral (TT-TG) en la superposición de imágenes en el plano axial. RESULTADOS: Hemos tenido resultados satisfactorios tanto con la transferencia de la tuberosidad tibial anterior como con la trocleoplastía. En ambos procedimientos se realizó una reconstrucción del ligamento patelofemoral medial (LPFM). CONCLUSIONES: La recurrencia de inestabilidad es muy rara después de estos procedimientos y es más probable que ésta resulte de anomalías asociadas no diagnosticadas o subestimadas. Se requiere una planificación precisa preoperatoria para determinar la altura rotuliana, la ubicación de la tuberosidad tibial anterior y la configuración troclear para obtener resultados satisfactorios.

Evaluation of a new dispersion technique for assessing triboelectric charging of powders.

In a number of applications, especially in pharmaceutical drug development, there is often a very small powder quantity available for evaluating the manufacturability of new drugs. However, it is highly desirable to be able to quickly evaluate processing issues, and where possible using the smallest powder quantity. In the present work, a proprietary commercial powder dispersion device (the disperser of Malvern© Morphologi G3) is adapted to evaluate the triboelectric charging tendency. A very small powder quantity (as small as 0.1 mg) is dispersed by a pressure pulse of compressed gas such as air or nitrogen. This causes the particles to become air borne and collide with the containing walls, resulting in dispersion and leading to triboelectric charge transfer between the particles and the walls. In this work, the charging propensity of a number of materials is evaluated and the effect of particle surface functional groups on the tribo-electric charge transfer is analysed. Model materials with a well-defined shape (glass ballotini) but with different silane groups deposited on their surfaces as well as a number of organic crystalline particles (such as aspirin, α-lactose monohydrate and paracetamol) are tested. Following dispersion the particles move immediately to a Faraday cup placed directly underneath the disperser. Therefore, particle charge is measured with no decay. The method can differentiate charging of different polymorphs of the same material, different silane groups on the surfaces of glass ballotini and different crystal morphologies obtained from crystallisation from various solvents.

[The quality of non-industrial confined environments: thermal discomfort]. / La qualità degli ambienti confinati non industriali: il discomfort termoigrometrico.

This paper examines the problem of assessing thermal conditions in moderate working environments. Following a brief reminder of the fundamental principles of thermal comfort (in terms of balance equation, measurement techniques and indices of global and local thermal discomfort), the question of subjective assessment is discussed. Finally, a method of evaluation of thermal comfort is proposed.

Phenotype of the tomato high pigment-2 mutant is caused by a mutation in the tomato homolog of DEETIOLATED1.

Tomato high pigment (hp) mutants are characterized by their exaggerated photoresponsiveness. Light-grown hp mutants display elevated levels of anthocyanins, are shorter and darker than wild-type plants, and have dark green immature fruits due to the overproduction of chlorophyll pigments. It has been proposed that HP genes encode negative regulators of phytochrome signal transduction. We have cloned the HP-2 gene and found that it encodes the tomato homolog of the nuclear protein DEETIOLATED1 (DET1) from Arabidopsis. Mutations in DET1 are known to result in constitutive deetiolation in darkness. In contrast to det1 mutants, tomato hp-2 mutants do not display any visible phenotypes in the dark but only very weak phenotypes, such as partial chloroplast development. Furthermore, whereas det1 mutations are epistatic to mutations in phytochrome genes, analysis of similar double mutants in tomato showed that manifestation of the phenotype of the hp-2 mutant is strictly dependent upon the presence of active phytochrome. Because only one DET1 gene is likely to be present in each of the two species, our data suggest that the phytochrome signaling pathways in which the corresponding proteins function are regulated differently in Arabidopsis and tomato.

A stochastic model of cellular transformation and its relevance to chemical carcinogenesis.

A mathematical model is presented which determines the relationship of cellular mutation to cellular survival and transformation. The basis for this model is the hypothesis that the entropy associated with changes of genotype are linearly proportional to the entropy associated with changes in phenotype. This hypothesis leads to a mathematical derivation relating cellular survival, mutation and transformation. The relevance of this model to data derived from experiments in chemical carcinogenesis is presented.

Dietary consumption of Lathyrus sativus seeds induces behavioral changes in the rat.

Neurolathyrism is a degenerative disorder due to an excessive consumption of Lathyrus sativus (LS) seeds, which contain the neurotoxic amino acid beta-N-oxalylamino-L-alanine. In this study, a population of Wistar rats was fed a diet with LS seeds up to 8 months. Two control groups were chosen, one receiving standard food and the other Cicer arietinum seeds (a nontoxic legume). At the end of the dietary period, the groups previously fed the seeds were switched to standard food for 1 month (wash-out). All animals were submitted to a neurological examination and observed in an open-field situation before, during the diet (at 4 and 8 months), and finally after wash-out. Neither LS-fed rats nor controls ever showed neurological deficits. By contrast, in an open-field the activity was significantly increased in the LS-eating rats at both the 4th and 8th month. The effect was indeed reversible, since it disappeared after the wash-out. It is suggested that the enhanced open-field activity seen in the LS group might indicate a reversible excitable status. However, there is no evidence at present that the behavioral changes described represent a marker of neurodegeneration in this animal species.

Clinical observations with a new specific assay for bone alkaline phosphatase: a cross-sectional study in osteoporotic and pagetic subjects and a longitudinal evaluation of the response to ovariectomy, estrogens, and bisphosphonates.

The purpose of this study was to examine the serum levels of bone alkaline phosphatase (BALP) measured with a new assay in normal and in osteoporotic women, and to evaluate prospectively its responsiveness to changes of bone metabolism. The following groups of subjects were studied: (1) 95 healthy women (44-75 years) (22 pre- and 73 postmenopausal) and 35 osteoporotic women [vertebral bone mineral density (BMD) more than 2.5 SD below the normal adult mean]; (2) 10 women (44-50 years) ovariectomized (OVX) for benign uterine diseases, examined before and 12 months after surgery; (3) 16 OVX women (36-54 years), examined before and after 12 months of transdermal estrogen replacement therapy (50 microg/day); (4) 12 previously untreated pagetic patients (4 women and 8 men, 50-80 years), examined before and 3 months after the I.V. administration of clodronate (600 mg) or alendronate (5 mg) for 2 consecutive days. The median BALP value was 11.6 U/liter (25-75th percentiles: 10.5-12. 7; range 7.7-19.3) in healthy premenopausal (PreMP) women and significantly higher (median: 16.8 U/liter; 25-75th percentile: 13. 8-21.8; P < 0.01) in postmenopausal (PostMP) women. There was a clear age-related increase in normal subjects (r = 0.43; P < 0.001). In the osteoporotic group, BALP levels, as well as other biochemical parameters of bone turnover, were not significantly different from those of normal women when adjusted for age. In OVX women, BALP levels showed a marked increase 12 months after surgery (median: 113%; 25-75th percentile: 87-139%), significantly higher than the increase of total ALP (median: 43%; 25-75th percentile: 25-66%; P < 0.001), and similar to the increases of serum osteocalcin and urinary hydroxyproline. Transdermal estrogen treatment prevented the BALP increase, even if no reduction was observed; total ALP showed a similar behavior. The basal levels of BALP were significantly elevated in pagetic patients (median: 91 U/liter; range 18-610 U/liter) and correlated to the scintigraphic extent of the disease (r = 0.76; P < 0.01). Three months after the I.V. administration of bisphosphonates, the decrease of BALP was more marked than that of total ALP (median: -54% versus -41%; P < 0.05). In conclusion, these results suggest that BALP measurement with this immunoassay may be clinically useful, and more sensitive than total ALP, in the assessment of bone turnover during changes of the estrogen status as well as in monitoring the effects of treatments that modify the metabolic activity of the skeleton.

Acute effects of bisphosphonates on new and traditional markers of bone resorption.

Bisphosphonates are known to be potent inhibitors of osteoclast activity and their only clinically relevant effect in the short-term is the selective inhibition of bone resorption. The purpose of this study was to compare the response to the intravenous administration of two bisphosphonates, clodronate and alendronate, of several biochemical markers of bone resorption, including tartrate-resistant acid phosphatase (TRAP) and cross-linked carboxyterminal telopeptide of collagen I (ICTP) in serum and hydroxyproline (OHP), free pyridinium cross-links (Pyr), and cross-linked N-telopeptides of collagen I (NTx) in urine. The study was carried out on 11 osteoporotic and 12 Pagetic subjects of both sexes, treated with clodronate (600 mg/day for 2 days) or alendronate (5 mg/day for 2 days), and monitored for 28 days after bisphosphonate administration. All the urinary markers of bone resorption showed a prompt decline after bisphosphonates, with maximum reductions after 7-14 days: Pyr decreased by 43% +/- 9% and 42% +/- 22% (mean +/- SD), respectively in osteoporotic and pagetic subjects, OHP by 51% +/- 14% and 51% +/- 20%, and NTx by 55% +/- 15% and 65% +/- 26%. In the osteoporotic group, the urinary markers began to increase again at 30 days, though still remaining well below the basal level, whereas in the pagetic group, the excretion of all markers remained depressed until the end of the observation period. The reduction of NTx was significantly greater than that of Pyr and OHP in pagetic patients (P < 0.05) and tended to be greater than that of Pyr in osteoporotic patients (p = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiologic study of femoral neck fractures in the province of Parma (1980-1992)]. / Indagine epidemiologica sulle fratture del collo del femore nella provincia di Parma (1980-1992).

Fractures of the femoral neck are one of the most important and severe complications of osteoporosis. To obtain up-to-date estimates on the frequency of these fractures in the province of Parma, a city of northern Italy, a retrospective study on the incidence of hip fractures has been carried out examining the operative records of all the orthopedic departments serving the whole province. Between January 1980 and December 1992, 3774 operations for hip fractures were performed, with a marked prevalence in women (2830 women and 944 men) and an exponential increase with age in both sexes. The incidence of extracapsular hip fractures was slightly higher and in women increased more rapidly with age than intracapsular fractures. Approximately 3 fractures out of 4 in women and 2 out of 3 in men occurred after the age of 75. Between 1980 and 1992, the age-adjusted annual incidence rose significantly by 7.1 cases per 100,000 per year in women and by 2.7 cases per 100,000 per year in men. When compared to other populations, these estimates indicate that the incidence of hip fractures in this province of Northern Italy is lower than that reported in other countries, especially in Northern Europe.

Role of GABA and opioids in the regulation of the vasopressin response to physical exercise in normal men.

The present study was undertaken in order to establish the possible involvement of GABAergic and/or opioid pathways in the mechanism underlying the arginine-vasopressin (AVP) response to physical exercise. After fasting overnight, seven subjects were tested on four mornings at least 1 week apart. Exercise was performed on a bicycle ergometer. The workload was gradually increased at 3 min intervals until exhaustion and lasted about 15 min in all subjects. Tests were carried out under administration of placebo, the opioid antagonist naloxone (10 mg as an i.v. bolus injection), the GABAergic agonist sodium valproate (600 mg in three divided doses orally) or naloxone plus sodium valproate. Plasma AVP levels rose 4-fold during exercise. The administration of naloxone did not modify, whereas sodium valproate completely abolished the plasma AVP rise during exercise. When naloxone was given together with sodium valproate, AVP rose 3-fold in response to exercise. These data suggest the involvement of a GABAergic mechanism in regulation of the AVP response to physical exercise in men. Furthermore, the data argue against a role of naloxone sensitive endogenous opioids in the control of AVP during exercise, whereas they suggest a partial opioid mediation of the GABAergic inhibitory action.