Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis.

We evaluated three risk assessment tools, including bone mineral density (BMD) measurement by dual energy X-ray absorptiometry (DXA), osteoporosis self-assessment tool for Asians (OSTA), and fracture risk assessment tool (FRAX), for the prediction of fracture status among Chinese patients undergoing hemodialysis. All of the three assessment tools have a reasonable capability in discriminating fractures. INTRODUCTION: Fractures are common in hemodialysis patients however insufficiently assessed. Our study aimed to assess the ability of three widely used tools [BMD, OSTA, and FRAX] to discriminate fracture status in patients with renal failure undergoing hemodialysis. METHODS: We enrolled 136 hemodialysis patients in a tertiary teaching hospital setting. BMD was measured using DXA at the lumbar spine and the hip region. OSTA was calculated from weight and age. FRAX score was calculated based upon online availability. Discriminative abilities of BMD, OSTA, and FRAX in fracture status were analyzed by receiver operator characteristic (ROC) curves. RESULTS: There were total 16 fractures (11.76 %) identified in 136 hemodialysis patients. BMD at any site (lumbar spine L1-L4, femoral neck, and total hip) was independently associated with fracture. Areas under the curves (AUC) of BMD (lumbar spine L1-L4, femoral neck, total hip), OSTA, FRAX1 (non-BMD model), and FRAX2 (BMD model) were 0.669 (95 % CI 0.583, 0.747), 0.708 ( 95 % CI 0.624, 0.783), 0.736 (95 % CI 0.654, 0.808), 0.686 (95 % CI 0.601, 0.763), 0.715 (95 % CI 0.631, 0.789), and 0.697 (95 % CI 0.613, 0.773), respectively. The differences of their performance were not significant. CONCLUSIONS: All of the three risk assessment tools had the ability to discriminate fracture status among hemodialysis patients; FRAX BMD model did not improve the discriminative ability of BMD or FRAX non-BMD model alone.

Unexpected results from large-scale cryptosporidiosis screening study in calves in Tanzania.

A study was undertaken to investigate Cryptosporidium infection in crossbreed dairy calves in two districts in Tanzania. A total of 943 fecal samples from 601 dairy calves were included in the study, with calves from both smallholder dairy farms and from large-scale and medium-scale dairy farms. The modified Ziehl-Neelsen (mZN) technique was used to examine 710 samples, and 13 of these were considered to be positive for Cryptosporidium. These 13 samples considered positive by mZN, along with the remaining 233 samples, were analysed by immunofluorescent antibody test (IFAT). Of these 246 samples examined by IFAT, 15 samples, 10 of which were considered positive by mZN, were also examined by the auramine phenol technique, and 5 samples, all of which were considered positive by mZN, were analysed by PCR. The results from the IFAT, auramine phenol and PCR analyses demonstrated that none of the samples contained Cryptosporidium oocysts, indicating that, cryptosporidiosis is currently not a problem in dairy calves in these regions of Tanzania. These unexpected results are discussed with respect to other reports on cryptosporidiosis in calves that suggest that this parasite is a serious calf disease globally, and particularly in relation to studies from Tanzania. We suggest that results from studies of cattle in Tanzania, in which mZN has been used as the sole analytical method, should be treated with caution.

Time course of training-induced microcirculatory changes and of vegf expression in skeletal muscles of spontaneously hypertensive female rats.

Exercise-induced vessel changes modulate arterial pressure (AP) in male spontaneously hypertensive rats (SHR). Vascular endothelial growth factor (VEGF) is important for angiogenesis of skeletal muscle. The present study evaluated the time course of VEGF and angiogenesis after short- and long-term exercise training of female SHR and Wistar Kyoto (WKY) rats, 8-9 weeks (200-250 g). Rats were allocated to daily training or remained sedentary for 3 days (N = 23) or 13 weeks (N = 23). After training, the carotid artery was catheterized for AP measurements. Locomotor (tibialis anterior and gracilis) and non-locomotor skeletal muscles (temporalis) were harvested and prepared for histologic and protein expression analyses. Training increased treadmill performance by all groups (SHR = 28%, WKY = 64%, 3 days) and (SHR = 141%, WKY = 122%, 13 weeks). SHR had higher values of AP than WKY (174 +/- 4 vs 111 +/- 2 mmHg) that were not altered by training. Three days of running increased VEGF expression (SHR = 28%, WKY = 36%) simultaneously with an increase in capillary-to-fiber ratio in gracilis muscle (SHR = 19%, WKY = 15%). In contrast, 13 weeks of training increased gracilis capillary-to-fiber ratio (SHR = 18%, WKY = 19%), without simultaneous changes in VEGF expression. Training did not change VEGF expression and capillarity of temporalis muscle. We conclude that training stimulates time- and tissue-dependent VEGF protein expression, independent of pressure levels. VEGF triggers angiogenesis in locomotor skeletal muscle shortly after the exercise starts, but is not involved in the maintenance of capillarity after long-term exercise in female rats.

Time course of training-induced microcirculatory changes and of vegf expression in skeletal muscles of spontaneously hypertensive female rats

Exercise-induced vessel changes modulate arterial pressure (AP) in male spontaneously hypertensive rats (SHR). Vascular endothelial growth factor (VEGF) is important for angiogenesis of skeletal muscle. The present study evaluated the time course of VEGF and angiogenesis after short- and long-term exercise training of female SHR and Wistar Kyoto (WKY) rats, 8-9 weeks (200-250 g). Rats were allocated to daily training or remained sedentary for 3 days (N = 23) or 13 weeks (N = 23). After training, the carotid artery was catheterized for AP measurements. Locomotor (tibialis anterior and gracilis) and non-locomotor skeletal muscles (temporalis) were harvested and prepared for histologic and protein expression analyses. Training increased treadmill performance by all groups (SHR = 28 percent, WKY = 64 percent, 3 days) and (SHR = 141 percent, WKY = 122 percent, 13 weeks). SHR had higher values of AP than WKY (174 ± 4 vs 111 ± 2 mmHg) that were not altered by training. Three days of running increased VEGF expression (SHR = 28 percent, WKY = 36 percent) simultaneously with an increase in capillary-to-fiber ratio in gracilis muscle (SHR = 19 percent, WKY = 15 percent). In contrast, 13 weeks of training increased gracilis capillary-to-fiber ratio (SHR = 18 percent, WKY = 19 percent), without simultaneous changes in VEGF expression. Training did not change VEGF expression and capillarity of temporalis muscle. We conclude that training stimulates time- and tissue-dependent VEGF protein expression, independent of pressure levels. VEGF triggers angiogenesis in locomotor skeletal muscle shortly after the exercise starts, but is not involved in the maintenance of capillarity after long-term exercise in female rats.

Influence of pancreas transplantation alone on native renal function.

Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patients, when the risks of secondary complications of diabetes mellitus are greater than those of the surgical procedure and the posttransplant immunosuppression. As a decrease in native renal function is expected, we followed this parameter among patients who underwent PTA. From January 1997 through January 2005, we performed 69 PTA in 66 patients. All patients showed glucose hyperlability with hypoglycemic unawareness, or two or more diabetic complications as well as creatinine clearance (CrCl) > or = 45 mL/min. Immunosuppression was based on tacrolimus, mycophenolate mofetil and prednisone. Twenty-four hour CrCl were performed after all successful PTA. We divided patients in two groups according to the pretransplant CrCl: group 1, CrCl < or = 70 mL/min (n = 20) and group 2, CrCl > 70 mL/min (n = 25). The data were analyzed using Student's t-test (P < or = .05 was considered significant). Twenty-one patients were excluded from the analysis because of death (n = 5) or graft loss (n = 8) during the first year or follow-up shorter than 1 year (n = 8). The mean value of CrCl decreased 28.8% (85.0 +/- 31 versus 60.5 +/- 36 mL/min; P < .001). There was also a 39.3% reduction among group 1 subjects (P = .003), including 10 who displayed CrCl < or = 30 mL/min. There was also a 24.4% reduction among group 2 (P = .008), but no patient developed end-stage renal disease. In conclusion, native renal function decreased significantly after PTA, but was well tolerated among patients with CrCl > 70 mL/min. Patients with CrCl < 70 mL/min show a significant risk of worsened renal function.

Medical student attitudes toward drug addiction policy.

This study explores the attitudes and perceptions of medical students concerning patients with addictions and policy issues related to drugs. Over 1,250 students from 15 medical schools responded to an anonymous survey concerning their experience and training regarding addictions, and their level of support or opposition for various drug policy approaches. Medical students expressed general support for treatment funding and related demand reduction strategies, but the strength of their support was influenced more by their political orientation than their perception of the effectiveness of the strategy. Students who identified themselves as liberals more strongly favored demand reduction and alternatives strategies such as needle exchange programs and drug courts. Conservatives more strongly favored supply reduction strategies including harsher sanctions for users. Need for additional training in medical school was indicated by the fact that 20% reported no training in addictions.

Spontaneous bilateral vertebral artery dissections: case report and literature review.

Vertebral artery dissection (VAD) has been increasingly identified as a cause of ischemic stroke in young adults. We report the clinical and radiographic findings in a case of spontaneous bilateral VADs and review the literature on the causes, pathophysiology, diagnostic considerations, and treatment options for VAD. A 29-year-old man was admitted to our hospital after sudden onset of headache and nuchal rigidity that progressed to a posterior lateral medullary syndrome in a 2-week period. The diagnosis of bilateral VADs was based on findings on cranial magnetic resonance imaging and conventional angiography. The patient was given anticoagulant therapy and had no further neurologic deterioration. The differential diagnosis of craniocervical pain in young patients should include arterial dissection of the neck because early diagnosis and treatment may reduce the chances of long-term neurologic sequelae.