Malignant Transformation of Synovial Chondromatosis: A Systematic Review

Background:

Synovial chondromatosis (SCh) can undergo malignant transformation. Pathologic diagnosis of secondary synovial chondrosarcoma (SChS) is challenging and misdiagnosis may result in over- or undertreatment.

Method:

A systematic review revealed 48 cases of SChS published in 27 reports since 1957. Data was collected to identify findings indicative of SChS and outcomes of treatment.

Results:

At median follow-up of 18 months, patients were reported as alive (10%), alive without disease (22%), alive with disease (15%), dead of disease (19%), dead of pulmonary embolism (4%), and unknown (29%). Initial diagnosis of SChS (grade: low/unknown 48%, intermediate/high 52%) was after biopsy in 58%, local resection in 29%, and amputation in 13%. Seventy-four percent of patients underwent 1.8 (mean) resections. Patients treated prior to 1992 were managed with amputation in 79% of cases compared to 48% after 1992. Symptoms were present for 72 mos prior to diagnosis of SChS.

Synovial chondrosarcoma demonstrated symptom progression over several months (82%), rapid recurrence after complete resection (30%), and medullary canal invasion (43%). The SChS tumor dimensions were seldom quantified.

Conclusion:

Malignant degeneration of synovial chondromatosis is rare but can necessitate morbid surgery or result in death. Pathognomonic signs for SChS including intramedullary infiltration are present in the minority of cases. Progression of symptoms, quick local recurrence, and muscle infiltration are more suggestive of SChS. Periarticular cortical erosion, extra-capsular extension, and metaplastic chondroid features are non-specific. Although poorly documented for SChS, tumor size is a strong indicator of malignancy.

Biopsy and partial resection are prone to diagnostic error. Surgical decisions are frequently based on size and clinical appearance and may be in conflict with pathologic diagnosis.

Preoperative prediction of anterior cruciate ligament tibial footprint size by anthropometric variables

PURPOSE

The purpose of this study was to evaluate whether the ACL tibial footprint size can be predicted by anthropometric variables including height, weight, leg length, femur length, tibia length, and anteroposterior and mediolateral diameters of proximal tibia.

METHODS

This study included 209 out of the 378 eligible patients. The inclusion criterion was ACL with normal gross appearance. Patients with conditions that could have affected the measurement were excluded: torn ACL, osteophyte formation around the ACL tibial attachment, presence of inflammatory arthritis, or history of knee joint infection. According to the above criteria, 169 patients were excluded from this study; 138 had torn ACL, 24 had osteophyte around the ACL footprint, 5 had history of rheumatoid arthritis, and 2 had history of previous knee joint infection. The ACL tibial footprint was carefully dissected and measured during total knee arthroplasty. Anthropometric variables regarding bone lengths were measured on radiography. The association of the ACL tibial footprint size (length and width) with anthropometric variables was analysed using simple and multiple linear regression analyses.

RESULTS

The height, weight, leg length, femur length, tibia length, and the size of proximal tibia were associated with the ACL tibial footprint length and width. The ACL tibial footprint length could be predicted by the equation using tibia length: ACL tibial footprint length = -9.361 + 0.759 * (tibia length in cm) (R ² = 0.44, P < 0.001) and width by the equation using weight and tibia length: ACL tibial footprint width = -0.5615 + 0.279 * (tibia length in cm) + 0.0333 * (weight in kgs) (R ² = 0.17, P < 0.001). The concordance correlation coefficient for the measured and predicted values of ACL tibial footprint length and width showed moderate and low agreement, respectively (0.61, 95 % CI 0.53-0.68; 0.30, 95 % CI 0.21-0.38).

CONCLUSION

The ACL tibial footprint length and width are associated with anthropometric variables, especially with tibial length. The predictive equation developed from this study can serve as supplementary guides to determine the surgical techniques and graft options in preoperative planning of an individual ACL reconstruction.

LEVEL OF EVIDENCE

IV.

Enchytraeus crypticus fitness: effect of density on a two-generation study

Organisms' density can influence physiological processes related with fitness. In the present study we assessed the influence of organisms' density on the life-history parameters in two consecutive generations in Enchytraeus crypticus (Oligochaeta), a standard model in soil ecotoxicology. The densities tested were 1 (N1) and 20 (N20) organisms per replicate and 10 vs. 20 g of soil (for the 2nd generation test only). Results showed that reproductive output was affected by density, with organisms in N1 producing three times more juveniles per adult than when at N20. Organisms' length was affected by both density and space, i.e., organisms were smaller when less space available. Further, the density of parental generation (F0) had no influence on the endpoints reproduction and length assessed in F1, hence there was no transference of effects. These findings have potential implications in the standard Enchytraeid Reproduction Test, i.e. early mortality of the adults during toxicant exposure can affect the number and size of the offspring and the final results will also reflect the density related changes in reproduction.

Quantitative anatomy of the primary ossification center of the femoral shaft in human fetuses

Purpose

Early clinical distinction of congenital defects in the femur is extremely important, as it determines the prognosis of the development of the lower limb. This study was performed to quantitatively examine the primary center of ossification in the femoral shaft with respect to its linear, planar, and volumetric parameters.

Materials and methods

Using methods of CT, digital-image analysis, and statistics, the size of the primary ossification center of the femoral shaft in 47 spontaneously aborted human fetuses aged 17–30 weeks was studied.

Results

With no sex and laterality differences, the best fit growth dynamics for femoral shaft ossification center was modelled by the following functions: y = 5.717 + 0.040 × (age)² ± 2.905 (R² = 0.86) for its length, y = −3.579 + 0.368 × age ± 0.529 (R² = 0.88) for its proximal transverse diameter, y = −1.105 + 0.187 × age ± 0.309 (R² = 0.84) for its middle transverse diameter, y = −2.321 + 0.323 × age ± 0.558 (R² = 0.83) for its distal transverse diameter, y = −50.306 + 0.308 × (age)² ± 18.289 (R² = 0.90) for its projection surface area, and y = −91.458 + 0.390 × (age)³ ± 92.146 (R² = 0.88) for its volume.

Conclusions

The size of the femoral shaft ossification center displays neither sex nor laterality differences. The ossification center in the femoral shaft follows quadratic functions with respect to its length and projection surface area, linear functions with respect to its proximal, middle, and distal transverse diameters, and a cubic function with respect to its volume. The obtained morphometric data of the femoral shaft ossification center are considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the ultrasound diagnostics of congenital defects.

Preoperative prediction of the size of pure ductal carcinoma in situ using three imaging modalities as compared to histopathological size: does magnetic resonance imaging add value?

PURPOSE

The purpose of this study was to evaluate whether magnetic resonance imaging (MRI) and ultrasonography add value to traditional mammography in an Asian population with ductal carcinoma in situ (DCIS).

METHODS

Data of 244 patients with pure DCIS treated at Severance Hospital between 2013 and 2015 were analyzed retrospectively. Data extracted included age, preoperative diagnosis, tumor size on preoperative imaging studies, and final histopathological tumor type and size, including hormone receptor status. The extent of correlation between imaging and histopathological tumor sizes was evaluated using a variety of methods, including Bland-Altman analysis.

RESULTS

The mean patient age was 52.39 years (SD = 10.31). The mean measurements of the tumor on preoperative ultrasonography, mammography, MRI, and histopathology were 1.80 (SD = 1.23) cm, 2.97 (SD = 1.92) cm, 2.53(SD = 1.84) cm, and 1.88 (SD = 1.36) cm, respectively. The mean differences in tumor size between ultrasonography, mammography, and MRI compared with histopathology were -0.09 (SD = 1.39), 1.09 (SD = 1.89), and 0.65 (SD = 1.78), respectively. The correlation between the sizes was significant with r values for ultrasonography, mammography, and MRI of 0.447 (SE = 0.061), 0.375 (SE = 0.042), and 0.409 (SE = 0.043), respectively. Mammography and MRI estimated tumor size significantly better for patients older than 50 years (p = 0.045 and <0.001, respectively). Mammography also provided good estimation for patients with a body mass index under 25 (p = 0.041).

CONCLUSION

MRI is better at estimation of histopathological DCIS size compared with mammography. However, ultrasonography had better estimation compared with MRI and mammography, probably owing to the high breast density in this population.

Widespread microplastic ingestion by fish assemblages in tropical estuaries subjected to anthropogenic pressures

Our aim was to quantify microplastic ingestion by fish assemblages in two tropical Brazilian estuaries and to evaluate whether biological and ecological factors influence the ingestion of microplastics by fish species. Of 2233 fish from both estuaries (from 69 species) examined in this study, 9% of the individuals (24 species) had microplastics in their gut contents. Microplastic ingestion occurred irrespective of fish size and functional group. The diet of fish species was analyzed based on prey items identified in the fish's full stomach contents and five feeding guilds were defined. Microplastics were common throughout all feeding guilds. Low (average ingestion values 1.06±0.30 items/total fish) but widespread occurrence among estuaries also indicates proliferation of microplastic pollution. Our findings highlight the need to focus on assemblage level studies to understand the real magnitude of the problem and emphasize the urgency of mitigation measures directed at microplastic pollution in estuarine ecosystems.

Transcervical ultrasonographic examination of palatine tonsil size and its correlation with age, gender and body-mass index in healthy children

OBJECTIVE

Our aim was to assess the palatine tonsil size with transcervical ultrasonography in healthy children and to analyze whether the palatine tonsil size is correlated with age, gender and body-mass index (BMI).

METHODS

This series consisted of 680 healthy children (340 females, 340 males) who underwent transcervical ultrasonography for evaluation of palatine tonsil size. A total of seventeen age groups (range: 1-17 years) comprised of 40 children (20 females, 20 males) were constituted. Demographic data including gender, height, weight and BMI were noted. Correlation between baseline descriptive data and tonsil volume was investigated.

RESULTS

The average age was 102.51 ± 59.24 months (range: 12 to 204) and body-mass index was 17.50-5.16 kg/m2 (min: 12.4-max:25.8). The average tonsil volume was 1819.5-2023.5 mm³ (min:601, max: 4007). The tonsil volume did not differ significantly between females and males (p = 0.108). However, there was a significant difference between tonsil volumes of various age groups (p < 0.001). Tonsil size seemed to be greater in parallel with advancement of age (p < 0.001) and increased BMI (p < 0.001).

CONCLUSION

Transcervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils objectively. There were strongly positive correlations between age, BMI and palatine tonsil size in healthy children and variability with respect to descriptive characteristics must be considered during diagnostic procedures and preoperative evaluation.

ADVANCES IN KNOWLEDGE

In our study, we suggest that transcervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils. There were positive correlations between age, BMI and palatine tonsil size in healthy children.

Ossification center of the humeral shaft in the human fetus: a CT, digital, and statistical study

Purpose

The knowledge of the development of the humeral shaft ossification center may be useful both in determining the fetal stage and maturity and for detecting congenital disorders, as well. This study was performed to quantitatively examine the humeral shaft ossification center with respect to its linear, planar, and volumetric parameters.

Materials and method

Using methods of CT, digital image analysis, and statistics, the size of the humeral shaft ossification center in 48 spontaneously aborted human fetuses aged 17–30 weeks was studied.

Results

With no sex differences, the best-fit growth dynamics for the humeral shaft ossification center was modeled by the following functions: y = −78.568 + 34.114 × ln (age) ± 2.160 for its length, y = −12.733 + 5.654 × ln(age) ± 0.515 for its proximal transverse diameter, y = −4.750 + 2.609 × ln (age) ± 0.294 for its middle transverse diameter, y = −10.037 + 4.648 × ln (age) ± 0.560 for its distal transverse diameter, y = −146.601 + 11.237 × age ± 19.907 for its projection surface area, and y = 121.159 + 0.001 × (age)⁴ ± 102.944 for its volume.

Conclusions

With no sex differences, the ossification center of the humeral shaft grows logarithmically with respect to its length and transverse diameters, linearly with respect to its projection surface area, and fourth-degree polynomially with respect to its volume. The obtained morphometric data of the humeral shaft ossification center are considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the ultrasonic diagnostics of congenital defects.

Participation inequality in the National General Health Examination based on enterprise size

Background

Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers’ General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder.

Methods

The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14–17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively.

Results

Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2–0.3 for non-office workers vs. 0.8–2.0 for public officers.

Conclusion

Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.

Elliptical Fourier analysis: fundamentals, applications, and value for forensic anthropology

The numerical description of skeletal morphology enables forensic anthropologists to conduct objective, reproducible, and structured tests, with the added capability of verifying morphoscopic-based analyses. One technique that permits comprehensive quantification of outline shape is elliptical Fourier analysis. This curve fitting technique allows a form's outline to be approximated via the sum of multiple sine and cosine waves, permitting the profile perimeter of an object to be described in a dense (continuous) manner at a user-defined level of precision. A large amount of shape information (the entire perimeter) can thereby be collected in contrast to other methods relying on sparsely located landmarks where information falling in between the landmarks fails to be acquired. First published in 1982, elliptical Fourier analysis employment in forensic anthropology from 2000 onwards reflects a slow uptake despite large computing power that makes its calculations easy to conduct. Without hurdles arising from calculation speed or quantity, the slow uptake may partly reside with the underlying mathematics that on first glance is extensive and potentially intimidating. In this paper, we aim to bridge this gap by pictorially illustrating how elliptical Fourier harmonics work in a simple step-by-step visual fashion to facilitate universal understanding and as geared towards increased use in forensic anthropology. We additionally provide a short review of the method's utility for osteology, a summary of past uses in forensic anthropology, and software options for calculations that largely save the user the trouble of coding customized routines.

Quantitative anatomy of the growing clavicle in the human fetus: CT, digital image analysis, and statistical study

Purposes

Knowledge of dimensions of fetal long bones is useful in both the assessment of fetal growth and early detection of inherited defects. Measurements of the fetal clavicle may facilitate detection of numerous defects, e.g., cleidocranial dysplasia, Holt–Oram syndrome, Goltz syndrome, and Melnick–Needles syndrome.

Methods

Using the methods of CT, digital image analysis, and statistics, the size of the growing clavicle in 42 spontaneously aborted human fetuses (21 males and 21 females) at ages of 18–30 weeks was studied.

Results

Without any male–female and right–left significant differences, the best fit growth models for the growing clavicle with relation to age in weeks were as follows: y = −54.439 + 24.673 × ln(age) ± 0.237 (R² = 0.86) for length, y = −12.042 + 4.906 × ln(age) ± 0.362 (R² = 0.82) for width of acromial end, y = −4.210 + 2.028 × ln(age) ± 0.177 (R² = 0.77) for width of central part, y = −4.687 + 2.364 × ln(age) ± 0.242 (R² = 0.70) for width of sternal end, y = −51.078 + 4.174 × ln(age) ± 6.943 (R² = 0.82) for cross-sectional area, and y = −766.948 + 281.774 × ln(age) ± 19.610 (R² = 0.84) for volume.

Conclusions

With no sex and laterality differences, the clavicle grows logarithmically with respect to its length, width, and volume, and linearly with respect to its projection surface area. The obtained morphometric data of the growing clavicle are considered normative for their respective weeks of gestation and may be of relevance in the diagnosis of congenital defects.

Modulatory effects of Zn2+ ions on the toxicity of citrate- and PVP-capped gold nanoparticles towards freshwater algae, Scenedesmus obliquus

Gold nanoparticles (GNPs) are widely used for medical purposes, both in diagnostics as well as drug delivery, and hence are prone to release and distribution in the environment. Thus, we have explored the effects of GNPs with two distinct surface capping (citrate and PVP), and three different sizes (16, 27, and 37 nm) at 0.01-, 0.1-, and 1-mg L^-1 concentrations on a predominant freshwater alga Scenedesmus obliquus in the sterile freshwater matrix. We have also investigated how an abundant metal ion from freshwater, i.e., Zn²⁺ ions may modulate the effects of the selected GNPs (40 nm, citrate, and PVP capped). Preliminary toxicity results revealed that gold nanoparticles were highly toxic in comparison to zinc ions alone. A significant modulation in the toxicity of Zn ions was not noticed in the presence of GNPs. In contrast, zinc ions minimized the toxicity produced by GNPs (both CIT-37 and PVP-37), despite its individual toxicity. Approximately, about 42, 33, and 25% toxicity reduction was noted at 0.05-, 0.5-, and 5-mg L^-1 Zn ions, respectively, for CIT-37 GNPs, while 31% (0.05 mg L^-1), 24% (0.5 mg L^-1), and 9% (5 mg L^-1) of toxicity reduction were noted for PVP-37 GNPs. Maximum toxicity reduction was seen at 0.05 mg L^-1 of Zn ions. Abbott modeling substantiated antagonistic effects offered by Zn²⁺ ions on GNPs. Stability and sedimentation data revealed that the addition of zinc ions gradually induced the aggregation of NPs and in turn significantly reduced the toxicity of GNPs. Thus, the naturally existing ions like Zn²⁺ have an ability to modulate the toxicity of GNPs in a real-world environment scenario.

Chest Drain Size: the Debate Continues

Purpose of review

Small-bore chest tubes are widely used in the management of common pleural disease. Guidelines suggest that patients with malignant pleural effusions, pneumothorax and pleural infection may be successfully managed with small-bore drains. However, good quality data is often lacking. This article reviews the evidence for the treatment efficacy and potential adverse effects of different chest tube sizes.

Recent findings

In a large randomised study, the small difference in pain scores between large and small drains was not clinically significant. However, small-bore chest tubes commonly suffer from blockage or inadvertent removal, and may not be as effective in providing successful pleurodesis for malignant pleural effusions.

Summary

Although they may be effective in managing pleural infection, and less painful than large drains, small bore drains may be less effective for pleurodesis.

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

OBJECTIVE

To evaluate the effect size of type 2 diabetes mellitus (T2DM) on tuberculosis (TB) treatment outcomes and multi drug resistance (MDR).

METHODS

A cohort with 507 individuals with diagnosed TB included 183 with coexistence of T2DM and TB (TB-T2DM). Participants were identified at the time of TB diagnosis and followed during the course of TB treatment. Then we computed relative risks and adjustments by Cox proportional hazards for outcome variables (drug resistance, death, relapse, treatment failure), and the size of their effect as Cohen's-d.

RESULTS

Patients with TB-T2DM were more likely to remain positive for acid-fast bacilli after two months of anti-TB treatment RR = [2.01 (95% CI: 1.3, 3.1)], to have drug resistant (DR) [OR 3.5 (95% CI: 1.8, 6.7)] and multi-drug resistant (MDR) TB [OR 3.5 (95% CI: 1.8, 7.1)]. The Cohen's-d for DR or MDR in T2DM was 0.69 when compared with non-DM subjects. The T2DM patients had higher odds of resistance to isoniazid (OR 3.9, 95% CI: 2.01, 7.9), rifampicin (OR 3.4, 95% CI: 1.6, 7.2) and pyrazinamide (OR 9.4, 95% CI: 2.8, 25.6), and their effect sizes were ≥0.67. Patients with TB-T2DM (versus no DM) were more likely to present with MDR TB (HR 3.1; 95% CI: 1.7, 5.8; p < 0.001), treatment failure (HR 2.04; 95% CI: 1.07, 3.8; p = 0.02) and relapse (HR 1.86; 95% CI: 1.09, 3.1; p = 0.02), with effect size ≥0.34.

CONCLUSION

T2DM showed a substantial contribution to the presence of DR or MDR-TB and to adverse clinical outcomes during and after TB treatment. Our findings support the importance for routine screening of T2DM among newly-diagnosed TB patients in order to stratify them for immediate DR assessment, and highlight the need for clinical trials to evaluate variations to the standard TB treatment in TB-T2DM to prevent adverse treatment outcomes.

Polypoid lesions of the gallbladder: analysis of 1204 patients with long-term follow-up

BACKGROUND

Polypoid lesions of the gallbladder (PLG) are common, and most are benign. Few lesions are found to be malignant, but are not preoperatively distinguished as such using common imaging modalities. Therefore, we compared characteristics of benign and malignant PLGs in depth.

METHODS

We enrolled 1204 consecutive patients diagnosed with PLG at Taipei Veterans General Hospital between January 2004 and December 2013. Patients underwent either surgery or regular follow-up with various imaging modalities for at least 24 months. The mean follow-up duration was 72 ± 32 months.

RESULTS

Of 1204 patients, 194 underwent surgical treatment and 1010, regular follow-up. In addition, 73 % patients were asymptomatic. The mean PLG size was 6.9 ± 7.7 (range 0.8-129) mm; the PLGs of 337 patients (28 %) grew during their follow-up periods. The majority of PLGs (90.4 %) were single lesions, and 10.5 % of patients had associated gallstones. The PLGs of 20.1 % of surgical patients were malignant. Malignant PLGs were found in 32.4 % of patients ≥50 years old and in 4.7 % of those <50 years old (p < 0.001). Right quadrant abdominal pain, epigastric pain, and body weight loss were the three most common symptoms associated with malignancy. Malignant PLGs were significantly larger than benign lesions (means: 27.5 ± 18.4 mm vs. 12.3 ± 12.3 mm, respectively, p < 0.001). Notably, the size of 5 % of malignant PLGs was 3-5 mm, and that of 8 % was 5-10 mm. The negative predictive value for gallbladder malignancy was 92.8 % based on a size ≥10 mm and 100 % based on a size ≥3 mm.

CONCLUSIONS

Our study reassesses the PLG size that warrants more aggressive intervention. Cholecystectomy remains mandatory for PLGs > 10 mm, but should also be considered a definitive diagnostic and treatment modality for PLGs with diameters of 3-10 mm.

Fabrication of size-controlled linoleic acid particles and evaluation of their in-vitro lipotoxicity

The biological activities of fatty acids (FAs) can differ with size even for lipids of similar compositions. The aim of this study was to develop size-controlled FA particles and to evaluate their toxicity as a function of size. Well-stabilized nano- and microscale linoleic acid (LA) were fabricated based on specific physical factors. Then, resulting LAs were characterized by size distribution, surface charge, assembly structure, composition, and serum effects. The sizes of the nano- (LA_nano) and microscale (LA_micro) LAs, determined by electron microscopy, were 109 nm and 12 μm, respectively. LA_nano, a multilamellar structure as determined by cryo-electron microscopy, was rapidly internalized into cells via free fatty acid receptor 3. After internalization, LA_nano, but not LA_micro, induced nuclear translocation of fatty acid binding protein 4 (FABP4). Translocation of FABP4 into the nucleus then induced expression of the FA metabolism-related genes InsR and AdipoR1. Their expression was significantly increased in the presence of only LA_nano. Cytotoxicity was also significantly increased in cells treated with LA_nano, but not LA_micro, as indicated by the endoplasmic reticulum stress markers CHOP and GRP78. Therefore, our results demonstrated that FAs with the same composition but varying in size can cause different cellular responses.

Bone mineral content and areal density, but not bone area, predict an incident fracture risk: a comparative study in a UK prospective cohort

We studied a prospective UK cohort of women aged 20 to 80 years, assessed by dual-energy X-ray absorptiometry (DXA) at baseline. Bone mineral content (BMC) and areal bone mineral density (aBMD), but not bone area (BA), at femoral neck, lumbar spine and the whole body sites were similarly predictive of incident fractures.

BACKGROUND

Low aBMD, measured by DXA, is a well-established risk factor for future fracture, but little is known about the performance characteristics of other DXA measures such as BA and BMC in fracture prediction. We therefore investigated the predictive value of BA, BMC and aBMD for incident fracture in a prospective cohort of UK women.

METHODS

In this study, 674 women aged 20-80 years, recruited from four GP practices in Southampton, underwent DXA assessment (proximal femur, lumbar spine, total body) between 1991 and 1993. All women were contacted in 1998-1999 with a validated postal questionnaire to collect information on incident fractures and potential confounding factors including medication use. Four hundred forty-three women responded, and all fractures were confirmed by the assessment of images and radiology reports by a research nurse. Cox proportional hazard models were used to explore the risk of incident fracture, and the results are expressed as hazard ratio (HR) per 1 SD decrease in the predictor and 95% CI. Associations were adjusted for age, BMI, alcohol consumption, smoking, HRT, medications and history of fracture.

RESULTS

Fifty-five women (12%) reported a fracture. In fully adjusted models, femoral neck BMC and aBMD were similarly predictive of incident fracture. Femoral neck BMC: HR/SD = 1.64 (95%CI: 1.19, 2.26; p = 0.002); femoral neck aBMD: HR/SD = 1.76 (95%CI: 1.19, 2.60; p = 0.005). In contrast, femoral neck BA was not associated with incident fracture, HR/SD = 1.15 (95%CI: 0.88, 1.50; p = 0.32). Similar results were found with bone indices at the lumbar spine and the whole body.

CONCLUSIONS

In conclusion, BMC and aBMD appear to predict incident fracture with similar HR/SD, even after adjustment for body size. In contrast, BA only weakly predicted the future fracture. These findings support the use of DXA aBMD in fracture risk assessment, but also suggest that factors which specifically influence BMC will have a relevance to the risk of the incident fracture.

Contrasting biological potency of particulate matter collected at sites impacted by distinct industrial sources

BACKGROUND

Industrial sources contribute a significant proportion of anthropogenic particulate matter (PM) emissions, producing particles of varying composition that may differentially impact health. This study investigated the in vitro toxicity of ambient PM collected near industrial sites in relation to particle size and composition.

METHODS

Size-fractionated particles (ultrafine, PM_0.1-2.5, PM_2.5-10, PM_>10) were collected in the vicinity of steel, copper, aluminium, and petrochemical industrial sites. Human lung epithelial-like A549 and murine macrophage-like J774A.1 cells were exposed for 24 h to particle suspensions (0, 30, 100, 300 μg/cm²). Particle potency was assessed using cytotoxic (resazurin reduction, lactate dehydrogenase (LDH) release) and inflammatory (cytokine release) assays, and regressed against composition (metals, polycyclic aromatic hydrocarbons (PAHs), endotoxin).

RESULTS

Coarse (PM_2.5-10, PM_>10) particle fractions were composed primarily of iron and aluminium; in contrast, ultrafine and fine (PM_0.1-2.5) fractions displayed considerable variability in metal composition (especially water-soluble metals) across collection sites consistent with source contributions. Semi-volatile and PM-associated PAHs were enriched in the fine and coarse fractions collected near metal industry. Cell responses to exposure at equivalent mass concentrations displayed striking differences among sites (SITE x SIZE and SITE x DOSE interactions, p < 0.05), suggesting that particle composition, in addition to size, impacted particle toxicity. While both J774A.1 and A549 cells exhibited clear particle size-dependent effects, site-dependent differences were more pronounced in J774A.1 cells, suggesting greater sensitivity to particle composition. Plotting particle potency according to cytotoxic and inflammatory response grouped particles by size and site, and showed that particles of similar composition tended to cluster together. Cytotoxic effects in J774A.1 cells correlated with metal and PAH content, while inflammatory responses were associated primarily with endotoxin content in coarse particles.

CONCLUSIONS

Industrial sources produce particulate emissions with varying chemical composition that differ in their in vitro potency in relation to particle size and the levels of specific constituents.

Variations of fine particle physiochemical properties during a heavy haze episode in the winter of Beijing

Chemical composition, morphology, size and mixture of fine particles were measured in a heavy haze and the post-haze air in Beijing in January 2012. With the occurrence of haze, the concentrations of gaseous and particulate pollutants including organics, sulfate, nitrate, and ammonium grew gradually. The hourly averaged PM2.5 concentration increased from 118μgm(-3) to 402μgm(-3) within 12h. In contrast, it was less than 10μgm(-3) in the post-haze air. Occupying approximately 46% in mass, organics were the major component of PM1 in both the haze and post-haze air. Analysis of individual particles in the size range of 0.2-1.1μm revealed that secondary-like particles and soot particles were always the majority, and most soot particles had a core-shell structure. The number ratio of secondary-like particles to soot particles in accumulation mode in the haze air was about 2:1, and that in the post-haze air was 8:1. These results indicate both secondary particle formation and primary emission contributed substantially to the haze. The mode size of the haze particles was about 0.7μm, and the mode size of the post-haze particles was 0.4μm, indicating the remarkable growth of particles in haze. However, the ratios of the core size to shell size of core-shell structure soot particles in the haze were similar to those in the post-haze air, suggesting a quick aging of soot particles in either the haze air or the post-haze air.

Clinical features of optic nerve head in healthy newborns

OBJECTIVE

To determine the size and clinical features of the optical disc in healthy term infants.

METHODOLOGY

Descriptive, observational, cross-sectional, and retrospective study based on complete medical records of newborns at the Angeles Pedregal Hospital, Mexico DF, from May to August 2015. The measurements of the optical disc and clinical features were obtained from digital photographs and evaluated by 2experts. Frequencies, means and standard deviation were calculated using the SPSS version 17.0 for Windows.

RESULTS

The study included a total of 121 patients and 121 eyes. There were 65 males. The mean vertical diameter was 1.60±0.17mm, horizontal diameter 1.31±0.13mm, optical disc area 1.43±0.26mm², and cup to disc ratio 0.25±0.11. The neuroretinal ring colour was orange in 116 (95.9%) eyes. The cribriform plate was not visible in any patient, and in 90 (74.4%) eyes the appearance of the vessels in the papilla was central, and nasal in the rest. The cilioretinal artery was present in 38 (31.4%) eyes. A hyper- and hypo-pigmented peripapillary ring was observed in 114 eyes (94.2%).

CONCLUSION

The mean area of the optic nerve is 1.43±0.26mm², slightly higher than previously reported. The mean cup to disc ratio is less than 0.3, as reported in the literature, and it is noteworthy that all eyes have a hyper-pigmented and hypo-pigmented peripapillary ring.

Role of nanoparticle size, shape and surface chemistry in oral drug delivery

Nanoparticles find intriguing applications in oral drug delivery since they present a large surface area for interactions with the gastrointestinal tract and can be modified in various ways to address the barriers associated with oral delivery. The size, shape and surface chemistry of nanoparticles can greatly impact cellular uptake and efficacy of the treatment. However, the interplay between particle size, shape and surface chemistry has not been well investigated especially for oral drug delivery. To this end, we prepared sphere-, rod- and disc-shaped nanoparticles and conjugated them with targeting ligands to study the influence of size, shape and surface chemistry on their uptake and transport across intestinal cells. A triple co-culture model of intestinal cells was utilized to more closely mimic the intestinal epithelium. Results demonstrated higher cellular uptake of rod-shaped nanoparticles in the co-culture compared to spheres regardless of the presence of active targeting moieties. Transport of nanorods across the intestinal co-culture was also significantly higher than spheres. The findings indicate that nanoparticle-mediated oral drug delivery can be potentially improved with departure from spherical shape which has been traditionally utilized for the design of nanoparticles. We believe that understanding the role of nanoparticle geometry in intestinal uptake and transport will bring forth a paradigm shift in nanoparticle engineering for oral delivery and non-spherical nanoparticles should be further investigated and considered for oral delivery of therapeutic drugs and diagnostic materials.

Marine protected area design patterns in the Mediterranean Sea: Implications for conservation

Mediterranean marine protected area (MPA) design patterns regarding geographic distribution, size, spacing and shape were analysed as a proxy of the region's MPA's ecological effectiveness and a first step towards an ecologically coherent MPA network. Results for legally designated MPAs and ecologically functional MPAs accounting for overlaps are presented. Geographically, Mediterranean MPA area is very unevenly distributed, with four-fifths concentrated in just three countries of the north-western part of the basin. Average distance between functional MPAs lies within recommended ecological thresholds, which suggests adequate potential connectivity of the Mediterranean MPA system. Mediterranean designated MPAs are larger than MPAs worldwide on average, although they are generally smaller than international guidance suggests at different levels: ecoregion, country and designation category. On average, Mediterranean designated and functional MPAs have relatively high compactness, which makes them prone to spillover and adequate viability, and less vulnerable to edge effects.

Debris size and buoyancy influence the dispersal distance of stranded litter

Recent at sea surveys of floating macro-debris in the southeast Atlantic Ocean found that debris increases in size with distance from shore, suggesting that many smaller items, which dominate litter close to urban source areas, sink before dispersing far into the ocean. We test whether this pattern is evident in beach litter in the same region. Freshly stranded beach litter was collected at increasing distances (0km, 100km, 200km and 2800km) from Cape Town, a major urban litter source. Mean size and buoyancy of litter items increased significantly with distance from Cape Town. Size-specific sedimentation due to the ballasting effect of biofouling is a plausible explanation for the disappearance of smaller, less buoyant items. Our results provide further evidence that many low buoyancy items sink and support the hypothesis that size and buoyancy are strong predictors of dispersal distance for floating debris.

Tooth Size in Patients with Mild, Moderate and Severe Hypodontia and a Control Group

Objectives:

To compare tooth size between subjects with mild, moderate and severe hypodontia and a control group.

Material and Methods:

The study comprised 120 patients with hypodontia divided into three groups of 40 mild (≤2 teeth congenitally missing), 40 moderate (3-5 teeth congenitally missing) and 40 severe (≥6 teeth congenitally missing) hypodontia; and 40 age and sex matched controls. Tooth size was recorded by measuring the mesiodistal and buccolingual dimensions of all fully erupted teeth on study models using digital callipers and compared between all hypodontia and control groups using Two-way ANOVA and Post Hoc Tests of subgroup comparison.

Results:

Two-way ANOVA revealed patients with hypodontia had significantly smaller mesiodistal and buccolingual tooth dimensions compared with controls (p<0.05). Furthermore patients with more severe hypodontia demonstrated significantly smaller tooth dimensions than those in the mild and moderate hypodontia subgroups (p<0.05). The most affected tooth in terms of tooth size reduction was the maxillary lateral incisor and the least affected tooth was the mandibular first molar.

Conclusion:

Patients with hypodontia have smaller tooth dimensions than control. Tooth size appears to be affected by the degree of hypodontia, with severe hypodontia having a greater effect on tooth size reduction. The findings of this study may contribute to understanding the aetiology of hypodontia and aid the multidisciplinary management of this complex condition.

Floating plastic debris in the Central and Western Mediterranean Sea

In two sea voyages throughout the Mediterranean (2011 and 2013) that repeated the historical travels of Archduke Ludwig Salvator of Austria (1847-1915), 71 samples of floating plastic debris were obtained with a Manta trawl. Floating plastic was observed in all the sampled sites, with an average weight concentration of 579.3 g dw km(-2) (maximum value of 9298.2 g dw km(-2)) and an average particle concentration of 147,500 items km(-2) (the maximum concentration was 1,164,403 items km(-2)). The plastic size distribution showed microplastics (<5 mm) in all the samples. The most abundant particles had a surface area of approximately 1 mm(2) (the mesh size was 333 μm). The general estimate obtained was a total value of 1455 tons dw of floating plastic in the entire Mediterranean region, with various potential spatial accumulation areas.