Trabecular bone score in people with cystic fibrosis.

People with cystic fibrosis (CF) are at increased risk of fractures. Our study found that low trabecular bone score (TBS) (a measure of bone strength) may help identify people with CF at risk of fractures especially when combined with bone density measured by DXA, age, hemoglobin A1c, and transplant status. INTRODUCTION: People with cystic fibrosis (CF) are at increased risk of fractures. This study aims to evaluate the association of trabecular bone score (TBS) with fractures in CF. METHODS: A cross-sectional study of adults with CF who completed bone density between 2009 and 2019. TBS was applied to lumbar spine studies. RESULTS: A total of 202 people with CF were included. A history of fracture was present in 36 (17.8%) subjects. Patients with history of fractures had higher hemoglobin A1c (A1C) (7.8 ± 2.7% vs. 6.7 ± 1.7%, p = 0.024), lower femoral neck (FN) Z/T-score (- 1.05 ± 1.08 vs. - 0.44 ± 1.08, p = 0.012), and lower TBS (1.36 ± 0.13 vs. 1.40 ± 0.11, p = 0.05) compared to those without. Lung transplant recipients had a higher prevalence of fractures (50% vs. 14.1%, p < 0.001). The odds ratio (95%CI) of having a fracture for subjects with TBS (≤ 1.2 vs. > 1.2) stratified by FN Z/T-score (≤ - 2.0 or > - 2.0) was 3.88 (0.92, 16.35), p = 0.07. ROC analysis showed TBS was significantly associated with fractures (p < 0.05); however, FN BMD was superior. A model combining FN BMD, age, A1c, transplant, and TBS improved ROC compared to FN BMD + age (0.837 vs. 0.779, p = 0.031). CONCLUSIONS: TBS ≤ 1.2 may identify people with CF at high risk of fractures. A model combining FN BMD, age, A1c, transplant, and TBS was significantly associated with fractures compared to FN BMD + age. Future studies are needed to evaluate the prediction of fractures in people with CF using clinical and bone parameters.

Measurement and implications of Saturn's gravity field and ring mass.

The interior structure of Saturn, the depth of its winds, and the mass and age of its rings constrain its formation and evolution. In the final phase of the Cassini mission, the spacecraft dived between the planet and its innermost ring, at altitudes of 2600 to 3900 kilometers above the cloud tops. During six of these crossings, a radio link with Earth was monitored to determine the gravitational field of the planet and the mass of its rings. We find that Saturn's gravity deviates from theoretical expectations and requires differential rotation of the atmosphere extending to a depth of at least 9000 kilometers. The total mass of the rings is (1.54 ± 0.49) × 1019 kilograms (0.41 ± 0.13 times that of the moon Mimas), indicating that the rings may have formed 107 to 108 years ago.

Isolated gastrointestinal metastasis of breast carcinoma: a case report.

Purpose. Gastrointestinal tract is one of the rare locations for breast cancer metastasis. This paper shows such metastasis may occur even in the absence of breast metastasis in other more common locations. Case Report. A 64-year old female was admitted to the hospital with abdominal discomfort and diarrhea. She had breast carcinoma treated 7 years previously with normal follow-up since. Colonoscopy showed hepatic flexure thickening that was confirmed to be breast metastasis. Staging investigations showed upper and lower gastrointestinal tract metastasis with negative findings elsewhere. Conclusion. Although more common causes for gastrointestinal symptoms should be excluded, however, a high index of suspicion of metastatic breast cancer is needed when such patients develop gastrointestinal symptoms.

Incidence of hypoglycemia with tight glycemic control protocols: a comparative study.

BACKGROUND: Comparison of hypoglycemia incidence among tight glycemic control (TGC) protocols is a crucial aspect that has not been done in previous trials. This study compared the incidence of hypoglycemia using three TGC protocols in critically ill patients. METHODOLOGY: This was a prospective study of 420 patients over 18 months. Patients were divided into three groups by TGC protocol: A (modified Leuven protocol), B (Georgia Hospital Association protocol, target blood glucose [BG] 80-110 mg/dL), and C (modified Georgia Hospital Association protocol, target BG 90-140 mg/dL). End points included differences in the incidence of first-degree hypoglycemia (BG or= 180 mg/dL). RESULTS: A total of 34,497 BG samples were analyzed: group A, 11,202 (32.47%); group B, 9,627 (27.91%); and group C, 13,668 (39.62%). First-degree hypoglycemia was more frequent in group A (348 episodes [3.11%]) compared to group B (209 episodes [2.17%] [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.25-1.172, P = 0.001]) and group C (266 episodes [1.95%] [OR 1.66, 95% CI 1.37-1.89, P = 0.001]). Second-degree hypoglycemia was more frequent in group A (131 episodes [1.17%]) compared to group B (62 episodes [0.64%] [OR 1.83, 95% CI 1.22-1.72, P = 0.001]) and group C (58 episodes [0.42%] [OR 2.77, 95% CI 2.04-3.79, P = 0.001]). No significant difference was found when groups B and C were compared (P = 0.10 and P = 0.06, respectively). Hyperglycemia was significantly more common in group A (2,175 episodes [19.42%]) compared to group B (1,333 episodes [13.83%] [OR 1.49, 95% CI 1.39-1.62, P = 0.001], but there was no significant difference compared to group C (2,560 episodes [18.73%] [P = 0.17]). CONCLUSIONS: TGC protocols vary in their risk of inducing hypoglycemia. Whether this translates into differences in clinical outcomes such as mortality and adverse effects is still to be determined by future studies.

Variaciones de la adaquia y fuerza labial superior en niños, tratados con mioterapia: Policlínico Tomás Romay: Habana Vieja / Open bite and upper labial's forces variations in children, treated with miotherapy: Tomas Romay Clinic, Old Havana

Se ha añadido a las etiologías existentes de la adaquia, o mordida abierta anterior, la incompetencia de los músculos labiales y se ha demostrado que pueden obtenerse resultados más estables y perfectos en su corrección sin necesidad de rejas inhibidoras de acción lingual, empleando tratamientos basados en la mioterapia. Con el propósito de determinar las variaciones que se producen en los valores de la fuerza labial y la adaquia después de mioterapia, se realizó un estudio experimental y longitudinal en 52 niños de 9-12 años, quienes asistieron a las escuelas del área de salud del Policlínico Tomás Romay en los años 2006-2007, para lo cual se realizaron mediciones con un dinamómetro modificado para medir la fuerza labial en gramos y con una regla milimetrada para medir la adaquia en mm. Nos apoyamos en la prueba de comparación de medias para muestras no independientes y pareadas para decidir si la intervención significaba las variaciones. Después del tratamiento, el promedio de la fuerza labial aumentó en todos los niños y la adaquia se redujo significativamente en igual período de tiempo. No hubo diferencias significativas en las respuestas al tratamiento entre hembras y varones. Se concluye que la mioterapia labial y lingual fue efectiva para aumentar la fuerza labial superior, reducir la mordida abierta anterior y lograr competencia labial en los niños del estudio después de 8 meses y al año de tratamiento, sin necesidad de una aparatología ortodóncica.

Labial muscles incompetence has been added to existent etiologies of open bite and it has been demonstrated that stable and perfect results can be obtained in their correction without necessity of grills inhibitors of lingual action, using miotherapy treatments. Purpose of determining variations take place in labial force values and open bite after miotherapy, was carried out an experimental and longitudinal study in 52 9-12 year-old children that attended the schools of the area of health of the Tomás Romay Clinic in 2006-2007, so was carried out mensurations with a dynamometry modified to measure labial force in grams and with millimeter rule to measure open bite in mm. Comparison test of stockings for non independent samples and paired to decide if intervention means variations was used. After treatment, average of labial force increased in all children and open bite decreased significantly in same period of time, there weren´t significant differences in answers to treatment between females and males. Concludes that labial and lingual miotherapy was effective to increase superior labial force, to reduce previous open bite and achieve labial competition in children including study after 8 months and year of treatment, without requirement of an Orthodontics apparatus.

Variaciones de la adaquia y fuerza labial superior en niños, tratados con mioterapia: Policlínico Tomás Romay: Habana Vieja / Open bite and upper labial's forces variations in children, treated with miotherapy: Tomas Romay Clinic, Old Havana

Se ha añadido a las etiologías existentes de la adaquia, o mordida abierta anterior, la incompetencia de los músculos labiales y se ha demostrado que pueden obtenerse resultados más estables y perfectos en su corrección sin necesidad de rejas inhibidoras de acción lingual, empleando tratamientos basados en la mioterapia. Con el propósito de determinar las variaciones que se producen en los valores de la fuerza labial y la adaquia después de mioterapia, se realizó un estudio experimental y longitudinal en 52 niños de 9-12 años, quienes asistieron a las escuelas del área de salud del Policlínico Tomás Romay en los años 2006-2007, para lo cual se realizaron mediciones con un dinamómetro modificado para medir la fuerza labial en gramos y con una regla milimetrada para medir la adaquia en mm. Nos apoyamos en la prueba de comparación de medias para muestras no independientes y pareadas para decidir si la intervención significaba las variaciones. Después del tratamiento, el promedio de la fuerza labial aumentó en todos los niños y la adaquia se redujo significativamente en igual período de tiempo. No hubo diferencias significativas en las respuestas al tratamiento entre hembras y varones. Se concluye que la mioterapia labial y lingual fue efectiva para aumentar la fuerza labial superior, reducir la mordida abierta anterior y lograr competencia labial en los niños del estudio después de 8 meses y al año de tratamiento, sin necesidad de una aparatología ortodóncica(AU)

Labial muscles incompetence has been added to existent etiologies of open bite and it has been demonstrated that stable and perfect results can be obtained in their correction without necessity of grills inhibitors of lingual action, using miotherapy treatments. Purpose of determining variations take place in labial force values and open bite after miotherapy, was carried out an experimental and longitudinal study in 52 9-12 year-old children that attended the schools of the area of health of the Tomás Romay Clinic in 2006-2007, so was carried out mensurations with a dynamometry modified to measure labial force in grams and with millimeter rule to measure open bite in mm. Comparison test of stockings for non independent samples and paired to decide if intervention means variations was used. After treatment, average of labial force increased in all children and open bite decreased significantly in same period of time, there weren´t significant differences in answers to treatment between females and males. Concludes that labial and lingual miotherapy was effective to increase superior labial force, to reduce previous open bite and achieve labial competition in children including study after 8 months and year of treatment, without requirement of an Orthodontics apparatus(AU)