Assessment of various traditional Chinese medicine formulas on skin micro-circulatory perfusion

Laser Doppler imagery is a contemporary form biomedical science specializing in non-evasive micro-circulation investigation. This paper outlines the process and results of applying twelve different test samples to mouse skin to collect data variation of micro-circulation, then judge the effects of different formulas in skin health improvement. More specifically, it is said [15] that micro-circulation is associated with anti-aging (otherwise known as micro-circulation acceleration) by the way of improvement of nutrition supply and hazard substance elimination, has some effects of skin anti-aging. In this paper, compared with Group 0 (the blank group), Group 1, and Group 2 formulas have statistically significant differences in skin micro-circulation perfusion, which implies that those two groups are provided with better anti-aging formulas. So, Group 1's formula and Group 2's formula have the most significant positive effect on the skin health.

Inhibitor of signal transducer and activator of transcription 3 (STAT3) suppresses ovarian cancer growth, migration and invasion and enhances the effect of cisplatin in vitro

The aim of the present study was to investigate the anti-ovarian cancer effect of the inhibitor of signal transducer and activator of transcription 3 (STAT3), WP1066. Western blot was used to detect the phosphorylation of STAT3 in ovarian cancer cell line SKOV3 and cisplatin-resistant ovarian cancer cell line SKOV3/DDP. MTT and colony-forming assays were performed to evaluate the viability and growth of ovarian cancer cells. The apoptosis of ovarian cancer cells was determined by flow cytometry. The wound healing assay and Transwell assay were performed to examine the migration and invasion of ovarian cancer cells. WP1066 significantly inhibited the phosphorylation of STAT3 in SKOV3 and SKOV3/DDP cells. WP1066 treatment inhibited the proliferation and clonogenicity of both SKOV3 and SKOV3/DDP cells. After WP1066 treatment for 24 h, the apoptosis rates of SKOV3 and SKOV3/DDP cells were significantly increased compared with the control cells. After treatment with WP1066, the reduction of the wound gaps was significantly less in both SKOV3 and SKOV3/DDP cells. WP1066 also significantly inhibited the invasion capacity of SKOV3 and SKOV3/DDP cells compared with the control group. Treatment with WP1066 combined with cisplatin significantly increased proliferation inhibition and apoptosis in SKOV3 and SKOV3/ DDP cells compared with treatment with cisplatin alone. A synergistic action between WP1066 and cisplatin on the proliferation and apoptosis of ovarian cancer cells was determined. In conclusion, inhibition of STAT3 may suppress the proliferation, migration and invasion, induce apoptosis and enhance the chemosensitivity of ovarian cancer cells, indicating that STAT3 is a new therapeutic target of ovarian cancer.

Poly(acrylic acid) modifying bentonite with in-situ polymerization for removing lead ions

In this paper, a new kind of poly(acrylic acid) modified clay adsorbent, the poly(acrylic acid)/bentonite composite (PAA/HB) was prepared by in-situ polymerization, and utilized to remove lead(II) ions from solutions. The maximum adsorption of adsorbent is at pH 5 for metal ions, whereas the adsorption starts at pH 2. The effects of contact time (5-60 min), initial concentration of metal ions (200-1,000 mg/L) and adsorbent dosage (0.04-0.12 g/100 mL) have been reported in this article. The experimental data were investigated by means of kinetic and equilibrium adsorption isotherms. The kinetic data were analyzed by the pseudo-first-order and pseudo-second-order equation. The experimental data fitted the pseudo-second-order kinetic model very well. Langmuir and Freundlich isotherms were tried for the system to better understand the adsorption isotherm process. The maximal adsorption capacity of the lead(II) ions on the PAA/HB, as calculated from the Langmuir model, was 769.2 mg/g. The results in this study indicated that PAA/HB was an attractive candidate for removing lead(II) (99%).

Preparation of xanthated bentonite and its removal behavior for Pb(II) ions

Xanthate was successfully grafted onto bentonite by a relatively simple solution reaction. The obtained xanthated bentonite (XBent) was characterized by FT-IR spectrophotometer, thermogravimetric analysis (TG), particle size analysis, x-ray diffraction (XRD) and scanning electron microscopy (SEM). XBent acting as a type of environmentally friendly adsorbent was applied to remove lead ions from aqueous solutions. The optimum conditions were as follows: [Pb(2+)] = 500 mg L(-1), [XBent] = 2 g L(-1), pH = 5.0; oscillating 60 min under 200 rpm at 25 degrees C. The removal rate of lead was up to 99.9%. It was found that the lead(II) ions-XBent adsorption isotherm model fitted well to the Freundlich isotherm. The adsorption mechanism was also investigated by SEM and XRD, which concluded that lead ions were complexed or chelated with XBent. XBent appears to have potential to be used later in water treatment as a type of inorganic polymer reagent.

Preparation of solid composite polyferric sulfate and its flocculation behavior for wastewater containing high concentration organic compounds

A new kind of inorganic polymer flocculant, the solid composite polyferric sulfate (SPFS) was prepared using ferrous sulfate and Na-Bentonite. The obtained SPFS was characterized by FT-IR spectra, thermogravimetric analysis (TG), scanning electron microscope (SEM) and X-ray Diffraction (XRD). It showed that SPFS was a kind of composite inorganic polymer, which was the complex of PFS and Na-Bent, not only a simple mixture of raw materials. The synthetic mechanism and surface structure of SPFS were also discussed. Acting as a kind of environment-friendly flocculating agent, the solid composite polyferric sulfate (SPFS) was applied in pretreatment of potato starch industry wastewater, a typical wastewater containing high concentration organic compounds, which COD was above 6,000 mg/L. The results showed that the COD removal value reached 4,070 mg/L with COD removal rates being 46.6%. Based on these results, it is suggested that the SPFS can be attractive pretreatment agent for the starch industry wastewater.

The role of citric acid on the phytoremediation of heavy metal contaminated soil

Adsorption and hydroponics experiments were conducted to study the role of citric acid on the phytoremediation of heavy metal contaminated soil. The results show that addition of citric acid decreased the adsorption of both lead and cadmium, such an effect was bigger for cadmium than for lead. The decrease in the adsorption of Pb and Cd was mainly due to a decrease of pH in the presence of citric acid. The presence of citric acid could alleviate the toxicity of Pb and Cd to radish, and stimulate their transportation from root to shoot. The studies of heavy metal forms using sequential extraction demonstrated that lead was mainly existed as FHAC (a lower bioavailable form) in the root, while F(HCl) was the dominant form in the leaf. The addition of citric acid to the soil changed the concentration and relative abundance of all the forms. The detoxifying effect of citric acid to Pb in shoots might result from the transformation of higher toxic forms into lower toxic forms. Cadmium was mainly present as F(NaCl), therefore, it had higher toxicity than lead. The addition of citric acid increased the abundance of F(H2O) + F(NaCl), indicating that citric acid treatment could transform cadmium into more transportable forms.

Rapid degradation of butachlor in wheat rhizosphere soil

The degradative characteristics of butachlor in non-rhizosphere, wheat rhizosphere, and inoculated rhizosphere soils were measured. The rate constants for the degradation of butachlor in non-rhizosphere, rhizosphere, and inoculated rhizosphere soils were measured to be 0.0385, 0.0902, 0.1091 at 1 mg/kg, 0.0348, 0.0629, 0.2355 at 10 mg/kg, and 0.0299, 0.0386, 0.0642 at 100 mg/kg, respectively. The corresponding half-lives for butachlor in the soils were calculated to be 18.0, 7.7, 6.3 days at 1 mg/kg, 19.9, 11.0, 2.9 days at 10 mg/kg, and 23.2, 18.0, 10.8 days at 100 mg/kg, respectively. The experimental results show that the degradation of butachlor can be enhanced greatly in wheat rhizosphere, and especially in the rhizosphere inoculated with the bacterial community designated HD which is capable of degrading butachlor. It could be concluded that rhizosphere soil inoculated with microorganisms-degrading target herbicides is a useful pathway to achieve rapid degradation of the herbicides in soil.

Effect of cadmium on nodulation and N2-fixation of soybean in contaminated soils

The effects of cadmium stress on nodulation, N2-fixation capabilities of the root nodule, the change in ultrastructure of the root nodule, soybean growth, and the distribution of cadmium in plants were studied. The results obtained show that the nodulation of soybean roots was greatly inhibited by the addition of Cd, especially at the addition level of 10 and 20 mg kg(-1) soil. The inhibition of plant growth, especially the root growth, increased as the cadmium concentration increased, with deleterious effects observed for the roots. The weight ratio of soybean root/leaf decreased as the Cd concentration increased, which might explain the reason for nodulation decreases. The results also indicate that N2-fixation of root nodule was stimulated to some extent at the low levels of Cd addition, but decreased sharply with further increase of the Cd concentration. High Cd levels were also associated with changes in the ultrastructure of root nodule, in which the effective N2-fixing area was reduced and the N2-fixing cells in the area also reduced. In addition, the results also reveal that the content of Cd in different parts of the plants was as follows: roots >> stems > seeds, indicating that the accumulation of Cd by roots is much larger than that by any other part of the soybean plant, and might cause deleterious effects to root systems.

Physiological mechanism of plant roots exposed to cadmium

Physiological experiments on plant roots exposed to cadmium were conducted on carrot and radish using a liquid culture and a pot experiment with a series of cadmium applications. Activities of four enzymes (catalase, peroxidase, polyphenol oxidase, superoxide dismutase), and concentrations of free proline and malonaldehyde in the roots of both plants were investigated. Results showed that the germination rate and growth of roots of both plants were inhibited at the concentration of 20 mg Cd/l, and the inhibition was increased with the increasing concentrations of cadmium, both in the liquid culture and in the pot experiment; activities of the four enzymes declined similarly in both species. The concentration of proline in roots reached the maximum when the application of cadmium was at the level of 20 mg/l in the liquid culture (or 20 mg/kg in soil), and then it declined slowly with the increasing concentration of cadmium. However, the reverse trend was observed for the concentration of malonaldehyde. All of bio-indicators measured here was quite sensitive to the addition of cadmium.

Matrix interference in serum total thyroxin (T4) time-resolved fluorescence immunoassay (TRFIA) and its elimination with the use of streptavidin-biotin separation technique

In our development of total serum thyroxin TRFIA using an immobilized second-antibody (S-Ab) as the separation agent, we observed a significant measurement bias caused by a matrix interference when the immobilized S-Ab had a relatively low binding capacity for the primary anti-T4 monoclonal antibody (McAb). Therefore, we employed a new separation system based on the highly active surface streptavidin and biotinylated anti-T4 McAb. Our results indicate that the matrix interference was removed and the assay performance was improved with the use of streptavidin-biotin separation technique. In our method, microwells were first coated with biotinylated BSA and then a streptavidin solution in the presence of 1% BSA was added to allow streptavidin to be immobilized via the pre-coated BSA-biotin. Surface streptavidin prepared in this protocol expressed a significantly increased binding capacity for the biotinylated anti-T4 McAb, compared to the passively adsorbed S-Ab for binding the original anti-T4 McAb. The immunoreactions between the biotinylated anti-T4 McAb and the T4 in the standard or sample or the europium-labeled T4-BSA conjugate mainly occurred in liquid solution, and then the immune complex was specifically trapped by the surface streptavidin and isolated from the free trace by washing. Serum TT4 TRFIA based on surface streptavidin was accurate, precise and economic, maintained all the merits of the directly immobilized surface antibodies.

The effect of neonatal capsaicin on the c-Fos-like immunoreactivity induced in subnucleus oralis neurons by noxious intraoral stimulation

The noxious stimulus-dependent induction of c-Fos-like immunoreactivity (Fos-LI) in neurons in the subnucleus oralis and the medullary dorsal horn (MDH) was significantly suppressed by the selective destruction of unmyelinated primary neurons. The induction of Fos-LI by topical capsaicin application to the lingual mucosal stimulation was almost completely suppressed by neonatal capsaicin treatment. Fos-LI induction by the tooth pulp stimulation and by formalin injection to the lingual mucosa were only partially reduced. These results provide an evidence that the noxious signals from the intraoral structures are transmitted by both unmyelinated and myelinated nociceptors to the subnucleus oralis as well as the MDH.

Noxious tooth pulp stimulation suppresses c-fos expression in the rat hippocampal formation

Changes in the expression of immediate early gene c-fos by noxious mechanical stimulation to the mandibular incisor pulp of rats were immunohistochemically examined in the hippocampus (Ammon's horn and dentate gyrus) and the retrohippocampus (subiculum, presubiculum, parasubiculum and entorhinal cortex). The highest control levels were found in subiculum, CA1, dentate and deep medial entorhinal cortex. Lower, but substantial levels were present in the other areas. Whereas weak dentinal stimulation caused increases in c-fos expression in some regions which were not statistically significant, strong tooth pulp stimulation caused a bilateral decrease in c-fos expression in every region except contralateral subiculum. These decreases reached statistical significance in superficial layer parasubiculum bilaterally (p<0.01), bilateral CA1 and ipsilateral side of superficial layer of medial entorhinal cortex (p<0.05). We suggest that inhibitory circuitry in hippocampal formation regions may be activated by peripheral noxious somatosensory inputs and this change in activity is accompanied by a change in the expression of the immediate early gene, c-fos.

Apoptotic cascade of neurons in the subcortical sensory relay nuclei following the neonatal infraorbital nerve transection

A terminal transferase-mediated dUTP nick end labeling (TUNEL) method was utilized for detection of neuronal death in the subcortical relay nuclei of the trigeminosensory system following the infraorbital nerve transection in newborn rats. At 18-24 h after injury, numerous TUNEL-positive profiles were found within the ventroposteromedial thalamic nucleus (VPM) contralateral to the injury, whereas the VPM on the ipsilateral side and of the age-matched normal control contained only a few profiles per section. Electron microscopy revealed that the TUNEL-positive profiles were apoptotic neurons. The ventral part of the ipsilateral brainstem sensory trigeminal nuclear complex (the nucleus principalis, and the subnuclei oralis and interpolaris) exhibited statistically significant 65-70% increase in number of apoptotic neurons compared to the contralateral side. Taken together with our previous study [T. Sugimoto, C. Xiao, H. Ichikawa, Neonatal primary neuronal death induced by capsaicin and axotomy involves an apoptotic mechanism, Brain Res. 807 (1998) 147-154], the present results demonstrated a cascade of apoptosis in the primary, secondary and tertiary order sensory neurons along the neuroaxis.

S100 protein-immunoreactive trigeminal neurons innervating the rat molar tooth pulp

S100-immunoreactivity (ir) was examined in tooth pulp primary neurons of the rat. An immunofluorescence method demonstrated that the molar tooth pulp contained S100-immunoreactive (ir) nerve fibers. In the root pulp, pulp horn and roof of the pulp chamber, S100-ir smooth and varicose fibers ramified and formed subodontoblastic nerve plexuses. All the fibers became varicose at the base of the odontoblastic layer and extended to the odontoblastic layer. Some varicose endings could be traced into the dentin. The trigeminal neurons retrogradely labeled with fluorogold (FG) from the first and second maxillary molar tooth pulps exhibited S100- and parvalbumin-ir. Approximately 60% and 24% of the labeled cells were ir for S100 and parvalbumin, respectively. Virtually all parvalbumin-ir FG-labeled cells showed S100-ir, while 40% of S100-ir ones coexpressed parvalbumin-ir. An immunoelectron microscopic method revealed that all myelinated axons and half of the unmyelinated axons in the root pulp contained S100-ir. In the odontoblastic layer, predentin and dentin, S100-ir neurites lost the Schwann cell ensheathment and made close contact with cell bodies and processes of odontoblasts. The odontoblastic layer also contained parvalbumin-ir neurites. These neurites were devoid of the Schwann cell ensheathment and in close apposition to cell bodies and processes of odontoblasts. S100-ir pulpal axons seemed to be insensitive to repeated neonatal capsaicin treatment. This study suggests that S100-ir tooth pulp primary neurons are mostly myelinated and that S100-ir unmyelinated axons in the root pulp are preterminal segments of myelinated stem axons.

Induction of immediate-early genes c-fos and zif268 in the subnucleus oralis by noxious tooth pulp stimulation

c-fos and zif268 expression were assessed by immunocytochemistry for c-Fos and Zif268 proteins in the sensory trigeminal nuclear complex following noxious mechanical stimulation of the mandibular incisor pulp of rats. Marked up-regulation of both immediate early genes was observed in the subnucleus oralis ipsilateral to the stimulation. Cavity preparation of the dentine without reaching the pulp did not cause significant up-regulation detectable by immunocytochemistry. These results provide evidence that noxious dental signals reach the ipsilateral subnucleus oralis and up-regulate the transcription of immediate early genes c-fos and zif268.

c-fos induction in the subnucleus oralis following trigeminal nerve stimulation

Neurons with c-Fos protein-like immunoreactivity (fos-neurons) were examined in the rostral parts of the brainstem sensory trigeminal nuclear complex following intense electrical stimulation of the trigeminal nerves and noxious mechanical stimulation of the trigeminal receptive fields. Stimulation of all the examined nerves and receptive fields induced some fos-neurons at the medial edge of the subnucleus interpolaris but not in the principal sensory trigeminal nucleus. Stimulation of the primary neurons innervating the intraoral structures but not facial skin induced fos-neurons in the ipsilateral subnucleus oralis. These oralis fos-neurons were located in the dorsomedial nucleus that contained calcitonin gene-related peptide-like immunoreactivity. The oralis fos-neurons are considered to be involved in the processing of intraoral nociceptive signals.

Trigeminal primary projection to the rat brain stem sensory trigeminal nuclear complex and surrounding structures revealed by anterograde transport of cholera toxin B subunit-conjugated and Bandeiraea simplicifolia isolectin B4-conjugated horseradish peroxidase

Trigeminal primary afferent neurons were labeled by injecting the rat trigeminal ganglion with either wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP), cholera toxin B subunit (B)-HRP or Bandeiraea simplicifolia isolectin B4 (IB4)-HRP. B-HRP stained medium to large cells (> 600 microm2), while IB4-HRP mostly small cells (< 400 microm2). WGA-HRP labeled trigeminal ganglion neurons of all sizes. Cell bodies in the mesencephalic trigeminal tract nucleus were labeled with WGA-HRP and B-HRP but not IB4-HRP. B-HRP revealed dense projection to the entire brain stem sensory trigeminal nuclear complex (BSTC) except for lamina II of the medullary dorsal horn (MDH). Some contralateral projection was also seen in the caudal part of MDH. Non-trigeminal nuclei receiving B-HRP-labeled terminals included the paratrigeminal nucleus (paraV), solitary tract nucleus, supratrigeminal nucleus, Probst's nucleus and median accessory nucleus. Following IB4-HRP application, terminal label was found in more restricted regions within the BSTC. Modest terminal label was seen in the dorsal part of principal sensory nucleus and at the medial edge of subnucleus interpolaris, while relatively dense terminal fields were seen in the dorsal half of subnucleus oralis. The MDH laminae I and II contained dense terminal label. Non-trigeminal nuclei were almost devoid of the IB4-HRP-labeled terminals excepting the paraV that contained dense terminal label. The terminal areas revealed with WGA-HRP coincided with B-HRP-labeled and IB4-HRP-labeled areas combined.

Central projection of calcitonin gene-related peptide (CGRP)- and substance P (SP)-immunoreactive trigeminal primary neurons in the rat

Substance P (SP) is implicated in transmission of primary afferent nociceptive signals. In primary neurons, SP is colocalized with calcitonin gene-related peptide (CGRP), which is another neuropeptide marker for small to medium primary neurons. CGRP coreleased with SP augments the postsynaptic effect of SP and thereby modulates the nociceptive transmission. This study demonstrates the distribution of CGRP-like immunoreactivity (-ir) and SP-ir in the lower brainstem of normal rats and after trigeminal rhizotomy or tractotomy at the level of subnucleus interpolaris (Vi). By comparing the results obtained from normal and deafferented rats, we analyzed the central projection of trigeminal primary nociceptors. The CGRP-immunoreactive (-ir) trigeminal primaries projected to the entire rostrocaudal extent of the spinal trigeminal nucleus, the principal nucleus (PrV), the paratrigeminal nucleus (paraV), and the lateral subnucleus of solitary tract nucleus (STN) on the ipsilateral side. The trigeminal primaries projecting to the spinal trigeminal nucleus, paraV and STN also contained SP-ir. The ipsilateral trigeminal primaries were the exclusive source of CGRP-ir terminals in the PrV, the Vi and the dorsomedial nucleus within the subnucleus oralis (Vo). The medullary dorsal horn (MDH) and the lateral edge of Vo received convergent CGRP-ir projection from the ipsilateral trigeminal primaries and other neurons. The glossopharyngeal and vagal primaries are candidates for the source of CGRP-ir projection to the Vo and the MDH, while the dorsal root axons supply the MDH with CGRP-ir terminals. In addition, contralateral primary neurons crossing the midline appear to contain CGRP and to terminate in the MDH.

Parvalbumin-immunoreactive nerve endings in the periodontal ligaments of rat teeth

Parvalbumin-immunoreactive nerve fibres were most abundant in the lingual periodontal ligaments of incisor teeth. In the part of the ligament adjacent to the alveolar bone, thick and smooth parvalbumin-immunoreactive nerve fibres left main nerve bundles and passed towards the part of the ligament adjacent to the tooth. In the ligament, halfway between the bone and tooth surfaces, these nerve fibres repeatedly branched and extended one to four twigs to produce bush-like endings. Parvalbumin-immunoreactive fibres and terminals were infrequent in the periodontal ligaments of the molar teeth. It is possible that parvalbumin-immunoreactive endings are periodontal mechanoreceptors, but at present it is difficult to account for the different representations around rat molar and incisor teeth.

Bax protein-like immunoreactivity in primary sensory and hypothalamic neurons of adult rats

Bax protein-like immunoreactivity (Bax-ir) was examined in the perfusion-fixed, cryosectioned rat nervous system. In the central nervous system, hypothalamic neurons were the only neurons that exhibited Bax-ir in the cell body. Their axons traveled toward the median eminence, suggesting that the Bax-like immunoreactive (Bax-ir) hypothalamic neurons included neurosecretory ones. Bax-ir axons were observed in the solitary tract nucleus, and spinal and medullary dorsal horns. They appear to have been derived from Bax-ir primary sensory neurons in the viscerosensory nodose ganglion and somatosensory dorsal root and trigeminal ganglia. In the somatosensory ganglia, smaller cells exhibited stronger Bax-ir. Accordingly, the ir axons in the dorsal horn were most concentrated in lamina II.

[Effect of (-) stepholidine on dopamine turnover in various brain regions]

It has been shown before that DA antagonist (-) stepholidine [(-) SPD] changes the function of feedback regulation in the striatum. In order to compare the effect of the drug on other brain DA systems, the DA content and DOPAC level in brain areas or nuclei of rat were measured by HPLC-ECD. It was found that (-) SPD (10 mg/kg, ip) did not significantly affect the DA contents in the striatum, olfactory bulb, N. accumbens, substantia nigra, ventral tegmentum area, N. amygdala, hypothalamus, pituitary, piriform cortex, but did markedly increase the DOPAC levels in these brain areas or nuclei, and thus increase the DA turnover (DOPAC/DA). However, (-) SPD (10 mg/kg, ip) did not significantly affect either the DA contents or DOPAC levels in the prefrontal cortex and cingulate cortex, thus leaving the DA turnover in these areas unchanges. These results indicated that (-) SPD did affect the nigro-striatal, midbrain-limbic and hypothalamus-pituitary DA systems, but not the midbrain-cortex DA system. It is supposed that this difference may be due to the modulation by presynaptic DA autoreceptors in the major brain areas of DA nerve endings or neurosoma, but none in the cortex DA nerve endings.

A randomized, double-masked, placebo-controlled trial of chlorthalidone and bone loss in elderly women

Employing a double-masked, prospective design, bone loss at three skeletal sites has been monitored among 113 postmenopausal women participating in a placebo-controlled trial of the thiazide-like diuretic chlorthalidone for treatment of systolic hypertension. The mean duration of chlorthalidone use was 2.6 years, at doses of 12.5-25 mg/day. Compared with placebo use, chlorthalidone use was associated with significant reductions in annual bone loss rates. Non-use of chlorthalidone was associated with bone loss at the calcaneus (-0.56% per year) and the proximal radius (-0.91% per year); borderline bone gain was observed at the distal radius (+0.39%). In contrast, chlorthalidone use was associated with bone gain at the calcaneus (+0.44% per year) and the distal radius (+1.51% per year); proximal radius bone loss was significantly reduced to -0.32% per year. The average increment for three appendicular sites was +0.9% per year. These data support a causal relationship between chlorthalidone use and reduced bone loss.

When should bone density measurements be repeated?

We calculated how long to wait before repeating bone mineral density (BMD) measurements to reassess fracture risk. Correlation results from serial measurements of 495 postmenopausal Japanese-American women were used to estimate 95% confidence intervals (CI) for future BMD. After 7 years of follow-up, BMD correlations with the initial measurement ranged between 0.81 and 0.94, depending on age group and measurement site. In this analysis, the period between measurements was defined as the time required for the lower 95% CI to fall below the BMD value corresponding to doubling of fracture risk. Progressive bone loss causes fracture risk to double after 10 years, on average. However, the 95% CIs indicate that a second BMD measurement will detect risk doubling after only 2 or 3 years for some women. For untreated, early postmenopausal women, the period between measurements was approximately 2-5 years for the radius and 4-6 years for the calcaneus, depending on the initial BMD level. The period was approximately 1 year longer for women age 60 and older. Treatments that halve the bone loss rate would increase the period by 1-3 years. In the absence of a second measurement of BMD, the CI will continue to expand with time, corresponding to a wider range in risk between individuals, and a greater proportion of women will be at increased fracture risk. Obtaining a second BMD measurement pinpoints the patient's status within the precision of the measurement. We conclude that repeated BMD measurements will provide a more accurate estimate of fracture risk than a single, baseline measurement.

Normal ranges for bone loss rates

We reported previously that the variability in bone loss rates among postmenopausal women decreases dramatically during the first few years of followup. In this paper, we have examined the distributions of bone loss rates measured at the calcaneus, distal radius and proximal radius. The incidence of physical impairment was five times greater among women with bone loss rates faster than 2 S.D. below the mean. Because the rate of change in bone density was skewed at the lower end of the distribution (representing rapid bone loss), the influence of values at the extreme ends of the distribution were statistically removed in order to estimate the normal distribution of bone loss rates. For the convenience of clinicians, the upper and lower limits of the 90 and 70% normal ranges are presented. Because average bone loss rates vary with age, normal ranges are provided separately by age group. The width of each normal range decreased by at least half after 3 or 4 years of followup, compared to less than 1 year. Consequently, measured loss rates which were well within the normal range at 1 year were sometimes far outside the normal range for longer followup times. We conclude that followup duration has a profound effect on estimates of the normal range, and must be considered when interpreting the clinical significance of measured loss rates.

Declining bone loss rate variability with increasing follow-up time

Bone loss rates are believed to vary substantially among post-menopausal women. The belief, however, might be largely based upon comparisons of loss rates measured with considerable error. This issue arises because the precision of the bone mass instrumentation (1-2% errors in measuring bone mass) is similar in magnitude to the loss rate (typically 1-2% of bone mass per year). The 'true' variability in loss rates, however, can be estimated by adjusting for instrument errors. An equation is presented which estimates the true variability in loss rates from a study sample. The adjustment was examined using a cohort of post-menopausal, Japanese-American women living in Hawaii. The study examined the calcaneus, distal, and proximal radius sites. The results suggest that measurement errors did not markedly inflate the bone loss variability. Even after adjustment for measurement errors considerable variability in loss rates remained. The variability was examined for various follow-up durations. Both the observed and adjusted loss rates had smaller standard deviations over long intervals than over short intervals. This result suggests that the more extreme rates of change in bone mass over a year or two were often not sustained. The implications of this finding for sample size calculations in longitudinal studies are examined. The results also indicate that the length of follow-up and instrument precision should be taken into consideration when comparing the proportion of fast losers between populations.