The time to and determinants of first fractures in boys with Duchenne muscular dystrophy.

Boys with vertebral fractures (VF) identified through routine spine radiographs had milder, less symptomatic, and fewer VF compared to those diagnosed with VF following consultation for back pain. Spontaneous (i.e., medication-unassisted) reshaping of fractured vertebral bodies was absent. Long bone fractures were present even before Duchenne muscular dystrophy (DMD) diagnosis in some boys. INTRODUCTION: The objective of the study was to determine the time to and characteristics of first fractures in Duchenne muscular dystrophy. METHODS: This study was a retrospective longitudinal study of 30 boys with DMD <18 years. Boys were classified into four groups according to their first fracture: those with VF identified on routine lateral spine radiographs, those with VF diagnosed following consultation for back pain, those with long bone fractures, and those without fractures. RESULTS: Compared to boys diagnosed with VF as their initial fracture following consultation for back pain, those with VF surveillance radiographs had shorter durations of glucocorticoid (GC) therapy at the time of VF diagnosis (median 1.6 versus 5.3 years, p < 0.01), higher areal (mean ± standard deviation -1.4 ± 0.7 versus -3.1 ± 0.8, p = 0.01), and volumetric (-0.3 ± 0.5 versus -2.6 ± 0.8, p < 0.01) lumbar spine bone mineral density Z-scores, as well as fewer VF (median 1.4 versus 5.2 per person, p < 0.01) and a lower median spinal deformity index (median 1.5 versus 9.5, p < 0.01). Vertebral body reshaping following VF was not observed. Ten boys sustained a long bone fracture as their first fracture at a mean age of 8.9 ± 4.0 years; four of these boys later sustained a total of 27 incident VF. CONCLUSIONS: Routine lateral spine radiographs led to detection of VF in their earlier stages, vertebral body reshaping following VF was absent, and VF were frequent after the first long bone fracture. These results support the inclusion of a lateral spine radiograph starting at the time of GC initiation as part of routine bone health monitoring in DMD.

Pancreatic acinar cell-specific overexpression of group 1B phospholipase A2 exacerbates diet-induced obesity and insulin resistance in mice.

Genome-wide association studies have identified significant association between polymorphisms of the Group 1B phospholipase A(2) (PLA2G1B) gene and central obesity in humans. Previous studies have shown that Pla2g1b inactivation decreases post-prandial lysophospholipid absorption, and as a consequence increases hepatic fatty acid oxidation and protects against diet-induced obesity and glucose intolerance in mice. The present study showed that transgenic mice with pancreatic acinar cell-specific overexpression of the human PLA2G1B gene gained significantly more weight and displayed elevated insulin resistance characteristics, such as impaired glucose tolerance, compared with wild-type (WT) mice, when challenged with a high-fat/carbohydrate diet. Pre- and post-prandial plasma ß-hydroxybutyrate levels were also lower, indicative of decreased hepatic fatty acid oxidation, in the hypercaloric diet-fed PLA2G1B transgenic mice. These, along with earlier observations of Pla2g1b-null mice, document that Pla2g1b expression level is an important determinant of susceptibility to diet-induced obesity and diabetes, suggesting that the relationship between PLA2G1B polymorphisms and obesity may be due to differences in PLA2G1B expression levels between these individuals. The ability of pancreas-specific overexpression of PLA2G1B to promote obesity and glucose intolerance suggests that target phospholipase activity in the digestive tract with non-absorbable inhibitors should be considered as a therapeutic option for metabolic disease therapy.

Large beta-delayed neutron emission probabilities in the 78Ni region.

The beta-delayed neutron branching ratios (P{betan}) for nuclei near doubly magic 78Ni have been directly measured using a new method combining high-resolution mass separation, reacceleration, and digital beta-gamma spectroscopy of 238U fission products. The P{betan} values for the very neutron-rich isotopes ;{76-78}Cu and 83Ga were found to be much higher than previously reported and predicted. Revised calculations of the betan process, accounting for new mass measurements and an inversion of the pi2p{3/2} and pi1f{5/2} orbitals, are in better agreement with these new experimental results.

Discovery of 109Xe and 105Te: superallowed alpha decay near doubly magic 100Sn.

Two new alpha emitters 109Xe and 105Te were identified through the observation of the 109Xe --> 105Te --> 101Sn alpha-decay chain. The 109Xe nuclei were produced in the fusion-evaporation reaction 54Fe(58Ni,3n)109Xe and studied using the Recoil Mass Spectrometer at the Holifield Radioactive Ion Beam Facility. Two transitions at Ealpha = 4062 +/- 7 keV and Ealpha = 3918 +/- 9 keV were interpreted as the l = 2 and l = 0 transitions from the 7/2+ ground state in 109Xe (T1/2 = 13 +/- 2 ms) to the 5/2+ ground state and a 7/2+ excited state, located at 150 +/- 13 keV in 105Te. The observation of the subsequent decay of 105Te marks the discovery of the lightest known alpha-decaying nucleus. The measured transition energy Ealpha = 4703 +/- 5 keV and half-life T1/2 = 620 +/- 70 ns were used to determine the reduced alpha-decay width delta2. The ratio delta105Te(2)/delta213Po(2) of approximately 3 indicates a superallowed character of the alpha emission from 105Te.

Primary wound closure in chronic osteomyelitis.

The sequelae of chronic osteomyelitis include not only the common clinical and radiographic signs and symptoms unique to it, but also the frequent residual deformity or amputation secondary to surgical intervention. Exacerbations and relapses are common and may occur as a result of trauma or a decrease in the resistance of the patient. Treatment of this condition over the years has been controversial. Some authors (1, 2) advocate treatment with high oral doses of antibiotics over a period of time up to 6 months. Although good results have been obtained with this regimen, other factors must be taken into account before initiation of such therapy such as severity and location of infection, drug allergy, renal and hepatic function, and attainable antibiotic blood levels. However, because of thrombosis of nutrient, marrow, and periosteal blood vessels, along with fibrosis of surrounding soft tissue, there is no guarantee that adequate serum antibiotic levels provide for the minimal inhibitory concentration of the drug in the infected bone. Antibiotic therapy without surgical intervention to improve blood supply cannot cure the disease and may result in an acquired resistance by the organism (3). The most widely accepted treatment today is surgical curetment, sequestrectomy, or resection of the infected osseous tissue with extensive debridement of all sinus tracts and devitalized tissues. Adding to the morbidity of this disease is the excessive scarring produced by inadequate and improper wound closure after surgical intervention. The following is a description of several methods utilized for contaminated wound closure.