Bone Turnover, Mineralization, and Volume Estimated by 18F-Sodium Fluoride PET/CT and Biomarkers in Chronic Kidney Disease: Mineral and Bone Disorder Compared with Bone Biopsy.

INTRODUCTION: Invasive bone biopsy to assess bone metabolism in patients with chronic kidney disease-mineral and bone disorder may be replaced by the noninvasive 18F-NaF PET/CT and biomarkers of bone metabolism. We aimed to compare parameters of bone turnover, mineralization, and volume assessed by bone biopsies with results derived from 18F-NaF PET/CT and biomarkers (bone-specific alkaline phosphatase, osteocalcin, fibroblast growth factor 23, and osteoprotegerin). METHODS: A cross-sectional study included 17 dialysis patients, and results from 18F-NaF PET/CT scans and the biomarkers were directly compared with the results of histomorphometric analyses of tetracycline double-labeled trans-iliac bone biopsies. RESULTS: Bone biopsies showed 40% high, 20% normal, and 40% low bone turnover. No biopsies had generalized abnormal mineralization, and the bone volume/total tissue volume was low in 80% and high in 7%. The pelvic skeletal plasma clearance (Ki) from 18F-NaF PET/CT correlated with bone turnover parameters obtained by bone biopsy (activation frequency: r = 0.82, p < 0.01; bone formation rate/bone surface: r = 0.81, p < 0.01), and Ki defined low turnover with high sensitivity (83%) and specificity (100%). CT-derived radiodensity correlated with bone volume, r = 0.82, p < 0.01. Of the biomarkers, only osteocalcin showed a correlation with turnover assessed by histomorphometry. CONCLUSION: In conclusion, 18F-NaF PET/CT may be applicable for noninvasive assessment of bone turnover and volume in CKD-MBD.

Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial.

OBJECTIVE: To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care. DESIGN: Interventional, randomised, safety/efficacy open-label trial. SETTING: University hospital stroke unit in collaboration with three municipalities. SUBJECTS: Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation. INTERVENTIONS: Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. MAIN MEASURES: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy. RESULTS: Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from P<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment. CONCLUSION: Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.

Different perceptions of thorax anatomy and hand placement for chest compressions among healthcare professionals and laypersons: Implications for cardiopulmonary resuscitation.

AIM: The European Resuscitation Council guidelines recommend that the hand position for chest compressions is obtained by "placing the heel of your hand in the centre of the chest". Importantly, guidelines are based on a study on healthcare professionals being extrapolated to laypersons. This study explored whether healthcare professionals and laypersons differ in anatomical knowledge necessary for obtaining the correct hand position for chest compressions and understanding of European Resuscitation Council guideline recommendations in the absence of a demonstration. METHODS: We asked laypersons and healthcare professionals to identify where to place the hands for chest compressions on digital pictures of the chest of a man and a woman. Both groups were asked to identify where to place the hands for chest compressions, the left nipple (positive control), the centre of the chest and to delineate the anterior area of the chest. RESULTS: In total, 50 laypersons and 50 healthcare professionals were included. Healthcare professionals were significantly better at identifying the correct hand position for chest compressions compared to laypersons (male chest: P = 0.03, female chest: P < 0.0001) and delineating the anterior area of the chest. We found no significant difference between groups when instructed to identify the left nipple nor the centre of the chest (male chest: P = 0.57, female chest: P = 0.50). CONCLUSION: Laypersons and healthcare professionals have different perceptions of chest anatomy and where to perform chest compressions suggesting that caution should be taken when extrapolating results from healthcare professionals to laypersons. The ERC 2015 guideline recommendations on hand placement for chest compressions seems understandable by both laypersons and healthcare professionals.

Technetium-99m-MAG3 and technetium-99m-DTPA: Renal clearance measured by the constant infusion technique - Old news?

BACKGROUND: Accurate, precise and straightforward methods for measuring glomerular filtration rate (GFR) and/or renal plasma flow (RPF) are still in demand today. The time-consuming constant infusion technique (CIT) is the gold standard and preferred for research, whereas the simple, but less precise, single injection technique (SIT) is used in clinical settings. This study investigated the use of 99m Tc-DTPA and 99m Tc-MAG3 by CIT as a measure of renal function. We developed and evaluated a model to balance the primer dose and infusion rate in an attempt to obtain plasma steady state as quickly as possible. METHODS: 14 healthy subjects received 99m Tc-DTPA and 6 hypertensive patients received 99m Tc-MAG3 in a standardized protocol. All participants had an eGFR above 60 ml/min and none had fluid retention. An intravenous primer injection of the relevant tracer was followed by a sustained infusion over 4.5 h with the same radiopharmaceutical. Blood and urine samples were collected at fixed intervals. RESULTS: 99m Tc-DTPA clearance reached steady state after 210 min (plasma clearance 78 ± 18 ml/min, urine clearance 110 ± 28 ml/min), whereas 99m Tc-MAG3  clearance achieved steady state after 150 min (plasma clearance 212 ± 56 ml/min, urine clearance 233 ± 59 ml/min). CONCLUSION: Constant infusion technique with fixed primer and infusion rate using 99m Tc-MAG3 is feasible for research purposes. The longer time for reaching plasma steady state using 99m Tc-DTPA makes CIT with this tracer less optimal. If the primer/sustained balance can be optimized, for example using a priori SIT information, 99m Tc-DTPA as tracer for CIT may also be feasible.

The influence of subluxation on the severity of symptoms, disability, and the results of operative treatment in TMC osteoarthritis with total joint arthroplasty.

BACKGROUND: The role of subluxation in staging of the severity of osteoarthritic changes remains unclear. The aim of this study was to evaluate the influence of subluxation of symptomatic osteoarthritic trapeziometacarpal (TMC) joint regarding severity of symptoms, disability, and results of operative treatment in TMC osteoarthritis with total joint arthroplasty. METHODS: We included 172 hands in 137 patients (32 males and 105 females), mean age 59 years (44-74 years), with a combination of radiological signs of TMC osteoarthritis and clinical symptoms in the study. All patients were operated in general anaesthesia where a ball and socket joint implant was used. Disability of the Arm, Shoulder and Hand (DASH) score, visual analog scale, grip strength, and abduction deficiency were recorded and subluxation was measured on computed tomography. RESULTS: The mean subluxation in males was 5.2 mm (SD 1.2) and in females 5.3 mm (SD 1.3) (p = 0.95). We found a weak positive correlation between grip strength and subluxation both at the preoperative examination and at 3 and 12 months after the operation, but no other correlations with subluxation were found. CONCLUSIONS: This study indicates that radial subluxation may not be an important factor in symptoms and function in patients with symptomatic TMC osteoarthritis without severe scaphotrapezio (ST) joint degeneration. In addition, preoperative subluxation seems not to be important for the result after total joint arthroplasty.

Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis.

OBJECTIVES: To examine the preferences of rheumatoid arthritis (RA) patients and health professionals (HPs) for the route and frequency of administration of biologic drugs. METHODS: One hundred and seven RA patients treated with biological agents for intravenous or subcutaneous use, 35 biologic-naïve RA patients treated with a disease-modifying antirheumatic drug and 30 rheumatology HPs (physicians and nurses) were recruited from two outpatient clinics in Copenhagen, Denmark. All subjects filled out a questionnaire interrogating their choice of preferred route and frequency of administration of a biologic corresponding to current available options, given that effects, adverse effects, and financial costs were identical for the different choices. The subjects were also asked to justify their preferences. The chi-square goodness-of-fit test was used to examine the distributions over different preferences. Proportions were compared using Fisher's exact test. RESULTS: Forty-one patients were currently treated with subcutaneous self-injections at home (SCH) and 66 intravenously at the clinic (IVC). IVC was preferred by 85% of patients currently treated with IVC (P<0.0001). SCH was preferred by 71% of patients currently treated with SCH (P<0.001), by 77% of the biologic-naïve patients (P<0.01), and by 87% of HPs (P<0.0001). The proportion of patients favoring SCH was significantly higher for patients currently receiving SCH and for biologic-naïve RA patients than for those currently on IVC (P<0.0001). SCH once a month and IVC every 8 weeks were the most appealing treatment frequencies (P<0.01). The most frequent reason among patients for choosing IVC or SCH was a wish for safety, and a wish to minimize the time of transportation and treatment, respectively. CONCLUSION: The majority of RA patients treated with biologics preferred their current route of administration. Most patients, those inexperienced with biologics, and HPs favored SCH. Low treatment frequencies were generally preferred.