Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group

OBJECTIVE

To determine whether postmenopausal estrogen replacement therapy is associated with a reduced risk of radiographic findings of osteoarthritis (OA) of the hip.

DESIGN

Cross-sectional study.

SUBJECTS

White women (N = 4366; age, > or = 65 years) who were participants in a cohort study of osteoporotic fractures.

MEASUREMENTS AND METHODS

Radiographs of the pelvis that were obtained in all subjects were assessed for radiographic features of OA of the hip on a summary scale of 0 (none) to 4 (severe OA). Postmenopausal estrogen use was assessed by interview. The association of current and past oral estrogen use with OA of the hip was analyzed by using logistic regression, adjusting for potential confounding variables (eg, indicators of osteoporosis and correlates of estrogen use).

RESULTS

Five hundred thirty-nine women (12.3%) had mild or greater radiographic findings of OA of the hip in at least 1 hip, and 214 women (4.9%) had moderate to severe findings; 17% and 24% of the women were current and past users of oral estrogen, respectively. Women who were currently using oral estrogen had a significantly reduced risk of any OA of the hip (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.49-0.86) and moderate to severe manifestation of disease (OR, 0.54; 95% CI, 0.33-0.88). Current users who had taken estrogen for 10 years or longer had a greater reduction in the risk of any OA of the hip (OR, 0.57; 95% CI, 0.40-0.82) compared with that of users for less than 10 years (OR, 0.75; 95% CI, 0.47-1.24). Current estrogen use for 10 years or longer was associated with a nonsignificant trend for a reduced risk of moderate to severe symptomatic disease (OR, 0.59; 95% CI, 0.28-1.29).

CONCLUSION

Postmenopausal estrogen replacement therapy may protect against OA of the hip in elderly white women.

Smoking and mortality among older women: the study of osteoporotic fractures

BACKGROUND

Relatively few studies have been focused on the effect of smoking among older individuals. The goal of this study is to investigate the relationship between smoking status and cause-and age-specific mortality among elderly women.

METHODS

Women aged 65 years and older and living in four geographical areas (Baltimore, Md, Minneapolis, Minn, Pittsburgh, Pa, and Portland, Ore) were recruited from various population-based listings for participation in the multicenter Study of Osteoporotic Fractures between September 1986 and October 1988 (N=9704). During a mean follow-up of 4.9 years (<99% complete), 751 deaths occurred. The date and cause of death were ascertained, and the relationship between mortality and current and past smoking status was analyzed using Cox proportional hazards modeling techniques.

RESULTS

Compared with nonsmokers, women smokers aged 65 to 74 years have a more than twofold increase in mortality attributable to increases in both cardiovascular and cancer mortality; death from smoking-related cancers increased eight- to 10-fold. Women 75 years and older who smoke have a small overall increased relative risk (RR) of mortality (RR=1.4; 95% confidence interval [CI], 0.9 to 2.3), but more than five-fold increased risk of dying from a smoking-related cancer (RR=5.2; 95% CI, 1.6 to 16.8). All-cause and cardiovascular death rates approach those of nonsmokers within 10 years after a woman quits smoking; morality from smoking-related cancers remains elevated for at least 23 years.

CONCLUSIONS

The harmful effects of continuing to smoke are apparent even among women aged 75 years and older.

The association of radiographic changes of osteoarthritis of the hand and hip in elderly women

OBJECTIVE

To examine the association of radiographic features of hand and hip osteoarthritis (OA) in elderly women.

METHODS

Hand and hip radiographs were read for changes of OA from a sample of 1422 women aged 65 and above who were participants in the Study of Osteoporotic Fractures. Definite hip OA required the presence of 2 or more of the following: moderate or large osteophytes, moderate or severe joint space narrowing, subchondral sclerosis, cysts, and femoral head deformity. Definite hand OA required moderate or large osteophytes at 2 or more of the following 6 sites: 2nd and 3rd distal and proximal interphalangeal joints and 1st interphalangeal and carpometacarpal joints. Data were analyzed using multiple logistic regression adjusting for age, weight at age 50, and current height.

RESULTS

Overall, 147 (10.4%) women had radiographic changes of definite hip OA and 68 (4.8%) had severe hip OA; 56 had bilateral and 87 had unilateral disease. Definite hand OA was present in 732 (51.4%) women. Hand OA was significantly associated with definite hip OA [odds ratio (OR) = 3.25, 95% confidence intervals (CI) 2.19, 4.84], and severe hip OA (OR = 3.23, 95% CI 1.82, 5.73). Hand OA was significantly associated with bilateral hip OA (OR = 3.54, 95% CI 1.87, 6.73) as well as unilateral hip OA (OR = 3.06, 95% CI 1.84, 5.08).

CONCLUSION

These data are consistent with the inclusion of radiographically defined hip OA in the construct of generalized OA, particularly in elderly women.

Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group

OBJECTIVE

To examine the cross-sectional association between radiographic features of hip osteoarthritis (OA) and bone mineral density (BMD) of the hip, spine, and appendicular skeleton among Caucasian women ages 65 and older who were participating in the Study of Osteoporotic Fractures.

METHODS

Pelvis radiographs of 4,855 subjects were assessed for individual radiographic features of hip OA: osteophytes, joint space narrowing, subchondral sclerosis, cysts, and femoral head deformity. Hips were graded on a summary scale of 0 (no OA) to 4 (severe OA) based on the number of radiographic features present. Appendicular BMD was measured in all subjects, and hip and spine BMD in 84% of the group. We used linear regression to examine the association of BMD with hip OA, and to adjust for age, weight, and other determinants of bone mass.

RESULTS

Three hundred fifty-one women (7.2%) had mild (grade 2) and 228 (4.7%) had moderate to severe (grade 3-4) radiographic evidence of hip OA. Women with grade 3-4 hip OA had a higher age-adjusted BMD at the femoral neck and Ward's triangle (9-10%; P < 0.0001), trochanter (4%; P < 0.01), lumbar spine (8%; P < 0.0001), and distal radius and calcaneus (5%; P < 0.0001 [for each comparison]) compared with those with grade 0-1 OA in the worse hip. Elevations in BMD were greatest in the femoral neck of hips with OA, in women with bilateral hip OA, and in women with hip osteophytes. These findings were essentially unchanged by adjustment for determinants of bone mass.

CONCLUSION

Elderly Caucasian women with moderate to severe radiographic hip OA had higher BMD in the hip, spine, and appendicular skeleton than did women without hip OA. Our findings are consistent with a role of elevated BMD in the pathogenesis of hip OA.

Gene cloning and complete nucleotide sequence of philippine Schistosoma japonicum paramyosin

The development of an effective vaccine is recognised as a necessary adjunct to the control of schistosomiasis japonica, a disease affecting several million people in China and the Philippines. Currently, recombinant Schistosoma japonicum molecules are considered most suitable for large scale vaccine production and a number of genes encoding vaccine candidate polypeptides have been cloned and expressed (see Waine et al., 1993a). One of the molecules providing most promise as a vaccine target is paramyosin (Butterworth, 1992), a major structural protein of thick filaments in the muscle of most invertebrates; paramyosin genes have now been cloned from a range of parasitic helminths, including schistosomes (Limberger and McReynolds, 1990; Laclette et al., 1991; Dahmen et al., 1993; Landa et al., 1993; Mühlschlegel et al., 1993, Nara et al., 1994). The cloning and nucleotide sequence of S. Japonicum paramyosin is described.

Survey of global telemedicine

The number and scope of telemedicine projects and applications world-wide are growing rapidly along with exponential expansions in national and international information infrastructures and computer capabilities to support them. To track these rapid changes, the Center for Public Service Communications (CPSC) of Arlington, VA, developed the Telemedicine and Information Technologies in Health Care: Project Tracking Document for the National Aeronautics and Space Administration (NASA). This document is maintained by CPSC and frequently updated. It tracks the following areas in telemedicine and health care informatics: (1) major existing Federal grant and other assistance programs and activities; (2) legislation effecting policy in these areas; (3) projects using various technologies throughout the US; and (4) telemedicine projects/interests in other nations. This paper is a survey of international (global) telemedicine activities that are outlined in that document.

Smoking, alcohol, and neuromuscular and physical function of older women. Study of Osteoporotic Fractures Research Group

OBJECTIVE

To determine the associations of current and lifetime smoking and alcohol use with physical function in an older population.

DESIGN

Survey.

SETTING

Four clinic centers in the United States.

PARTICIPANTS

A total of 9704 community-dwelling, ambulatory white women 65 years or older recruited from four areas of the United States.

MAIN OUTCOME MEASURES

Twelve performance tests of muscle strength, agility and coordination, gait and balance, and self-reported functional status.

RESULTS

Compared with women who never smoked, current smokers had significantly poorer function on all of the performance measures except grip strength after adjusting for age, history of stroke, body mass index, clinic site, physical activity, and alcohol use (P < .05). This decrease in function was 50% to 100% as great as that associated with a 5-year increase in age, and most measures worsened with increasing numbers of pack-years. Compared with current moderate drinkers, nondrinkers had significantly poorer function on all of the performance measures except tandem walk (P < .05). Evaluation of a dose effect with alcohol was limited by the small number of heavy drinkers in the study.

CONCLUSIONS

In this population, women who currently smoke are weaker and have poorer balance and poorer performance on measures of integrated physical function than nonsmokers. Smoking is associated with a decline in physical function. Current moderate drinkers have better physical function compared with nondrinkers, but associations of function with heavy drinkers could not be assessed.

Deficient expression of co-stimulatory molecules on Leishmania-infected macrophages

Co-stimulatory signals are necessary for the full activation of T cells for growth and effector function. As co-stimulatory molecules are normally regulated in their expression, it has been suggested that microorganisms enhance their expression on host antigen-presenting cells (APC), thus allowing efficient generation of anti-microbial immunity. We here describe experiments which demonstrate that infection of macrophages, both in vitro and in vivo, by the protozoan parasite Leishmania donovani fails to trigger expression of co-stimulatory molecules B7-1 and heat-stable antigen on these APC. Furthermore, infection with this parasite inhibits the macrophage response to normal regulatory signals, such as bacterial lipopolysaccharide. These changes in the cell surface are mirrored in functional studies of co-stimulation in vitro. Together, these data suggest a further facet of parasite interference in host immunity, but also indicate a potential new target for immunotherapy.

Purification of a recombinant Schistosoma japonicum antigen homologous to the 22-kDa membrane-associated antigen of S. mansoni, a putative vaccine candidate against schistosomiasis

We describe the cDNA cloning, overproduction and purification of a 22.6-kDa antigen from the human blood fluke Schistosoma japonicum. A 777-bp cDNA (C32) was isolated from a S. japonicum lambda ZAPII cDNA expression library immuno-screened with hyperimmune rabbit serum (HRS) raised against soluble adult S. japonicum proteins. The open reading frame of C32 encodes a protein of 191 amino acids (aa) which exhibits 71% identity to a 22.6-kDa membrane-associated antigen of S. mansoni, a putative vaccine candidate for schistosomiasis. We have identified a sequence motif known as an EF-hand calcium-binding domain in both the S. japonicum and S. mansoni aa sequences, suggesting that the 22.6-kDa antigens are able to bind Ca2+. Further, we have, for the first time, obtained the 22.6-kDa antigen in purified, non-denatured, recombinant form, and in sufficient quantity to assess the protective value of the molecule in vaccination/challenge experiments. This was achieved by synthesizing the schistosome antigen with a short polyhistidine tag fused to the N-terminus which was then used for subsequent affinity purification. The recombinant protein was purified under non-denaturing conditions using nickel-chelate affinity chromatography.

The random amplification of polymorphic DNA can discriminate species and strains of Echinococcus

The random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR), also called arbitrary priming PCR (AP-PCR), is a DNA polymorphism assay based on the amplification of genomic DNA using a single oligonucleotide primer of arbitrary nucleotide sequence. Using carefully controlled conditions, the random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) proved useful for distinguishing Echinococcus species and genetically distinct strains of Echinococcus granulosus. Amongst twenty random 10 mer oligonucleotide primers tested, 4 (5'-GGGAATTCGG-3', 5'-GGCTGCAGAA-3', 5'-GGAGTACTGG-3', 5'-CCTCTAGACC-3') were most suitable for producing complex but characteristic patterns for discrimination purposes. Although the method amplifies vertebrate DNA, the resulting patterns do not interfere with the identification of Echinococcus isolates. Consequently, the technique can still be used effectively to distinguish Echinococcus species and strains even if host contamination occurs during the course of parasite collection. The approach complements several other methods, based on direct DNA examination, recently developed in our laboratory, which also allow unambiguous discrimination of Echinococcus genotypes.

Diminished brain glucose metabolism is a significant determinant for falling rates of systemic glucose utilization during sleep in normal humans

Systemic glucose utilization declines during sleep in man. We tested the hypothesis that this decline in utilization is largely accounted for by reduced brain glucose metabolism. 10 normal subjects underwent internal jugular and radial artery cannulation to determine cerebral blood flow by N2O equilibrium technique and to quantitate cross-brain glucose and oxygen differences before and every 3 h during sleep. Sleep stage was graded by continuous electroencephalogram, and systemic glucose turnover was estimated by isotope dilution. Brain glucose metabolism fell from 33.6 +/- 2.2 mumol/100 g per min (mean +/- SE) before sleep (2300 h) to a mean nadir of 24.3 +/- 1.1 mumol/100 g per min at 0300 h during sleep (P = 0.001). Corresponding rates of systemic glucose utilization fell from 13.2 +/- 0.8 to 11.0 +/- 0.5 mumol/kg per min (P = 0.003). Diminished brain glucose metabolism was the product of a reduced arteriovenous glucose difference, 0.643 +/- 0.024 to 0.546 +/- 0.020 mmol/liter (P = 0.002), and cerebral blood flow, 50.3 +/- 2.8 to 44.6 +/- 1.4 cc/100 g per min (P = 0.021). Brain oxygen metabolism fell commensurately from 153.4 +/- 11.8 to 128.0 +/- 8.4 mumol/100 g per min (P = 0.045). The observed reduction in brain metabolism occurred independent of stage of central nervous system electrical activity (electroencephalographic data), and was more closely linked to duration of sleep. We conclude that a decline in brain glucose metabolism is a significant determinant of falling rates of systemic glucose utilization during sleep.

Reproductive correlates of bone mass in elderly women. Study of Osteoporotic Fractures Research Group

Results from previous studies of reproductive factors and bone density have been conflicting; some demonstrate a beneficial effect, but others show a detrimental effect on bone density. The present study investigates the association of parity, lactation, and menstruation with radial bone density in 2230 white women, 65 years of age and older. Bone density was assessed by single-photon absorptiometry. Linear multiple regression was utilized to determine if reproductive factors were associated with radial bone density. The number of births, duration of menstrual bleeding, age at menarche, and years menstruating were significant independent predictors of postmenopausal bone density of the radius. A 1.4% increase in distal radius bone density was observed with each additional birth. Women who began menstruation at age 9 had 6.3% higher bone density than women who began at age 16. Women who menstruated for 3 days during each menstrual cycle had 2.8% less distal radius bone density than women who bled for 7 days. Each decade of menstruation was associated with a 2% greater distal radius bone density. No difference in bone density was demonstrated for women who breast-fed and women who did not. Length of the menstrual cycle, amount of menstrual flow, and irregularity of the menstrual cycle were not significantly associated with radial bone mineral density. In conclusion, pregnancy and menstruation are associated with postmenopausal bone density of the radius.

Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group

OBJECTIVE

To determine the factors associated with appendicular bone mass in older women.

DESIGN

Cross-sectional analysis of baseline data collected for a multicenter, prospective study of osteoporotic fractures.

SETTING

Four clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela valley, Pennsylvania.

PATIENTS

A total of 9704 ambulatory, nonblack women, ages 65 years or older, recruited from population-based listings.

MEASUREMENTS

Demographic and historical information and anthropometric measurements were obtained from a baseline questionnaire, interview, and examination. Single-photon absorptiometry scans were obtained at three sites: the distal radius, midradius, and calcaneus. Multivariate associations with bone mass were first examined in a randomly selected half of the cohort (training group) and were then tested on the other half of the cohort (validation group).

RESULTS

In order of decreasing strength of association, estrogen use, non-insulin-dependent diabetes, thiazide use, increased weight, greater muscle strength, later age at menopause, and greater height were independently associated with higher bone mass. Gastric surgery, age, history of maternal fracture, smoking, and caffeine intake were associated with lower bone mass (all P < 0.05). For example, we found that 2 or more years of estrogen use was associated with a 7.2% increase in distal radius bone mass, whereas gastrectomy was associated with an 8.2% decrease in bone mass. The associations between bone mass and dietary calcium intake and rheumatoid arthritis were inconsistent. Alcohol use, physical activity, use of calcium supplements, pregnancy, breast-feeding, parental nationality, and hair color were among the many variables not associated with bone mass. Multivariate models accounted for 20% to 35% of the total variance of bone mass.

CONCLUSIONS

A large number of factors influence the bone mass of elderly women; however, age, weight, muscle strength, and estrogen use are the most important factors.

Functional improvement in geriatric trauma patients admitted to a dedicated rehabilitation hospital

A retrospective study was undertaken of trauma patients over 55 years of age who were admitted to a rehabilitation hospital during an 18-month period. Significant risk factors for poorer in-hospital improvement in functional independent measures were male sex, having an offspring listed as next of kin, pre-injury diabetes mellitus and/or dementia, and number of co-morbidities. Being married was found to be protective.

Subsecond grating growth in a photorefractive polymer

We survey the dynamics of the photorefractive effect in a methyl methacrylate copolymer with the nonlinear chromophore p-nitroaniline in a pendant side group doped with a charge-transport agent, diethylaminobenzaldehyde diphenylhydrazone, a material that represents a new class of photorefractive polymer. The grating growth times are several orders of magnitude smaller than that for the previous epoxy-based photorefractive polymers and fall below 1 s at the highest intensities used. Grating competition and revelation effects suggest that charge carriers other than photogenerated holes are mobile. A sublinear dependence of growth rate on writing intensity implies that shallow traps may also be present.

Lantibiotic-mediated anti-lactobacillus activity of a vaginal Staphylococcus aureus isolate

Staphylococcus aureus strain 26 inhibited the growth of 23 of 26 lactobacilli of endocervical origin, but only two of 17 staphylococci, in deferred antagonism tests. The inhibitory agent, a bacteriocin-like inhibitory substance (BLIS) named staphylococcin Au-26, was obtained from vigorously shaken liquid cultures containing a 0.1% (v/v) supplement of Tween 80 and was purified by chromatographic fractionation on XAD-2, carboxymethyl Sephadex and reversed phase HPLC. The molecular mass of staphylococcin Au-26 was estimated by SDS-PAGE to be approx. 2700. The detection of lanthionine residues in the molecule, the high stability to heating at acidic but not alkaline pH values and inactivation by proteinases indicate that staphylococcin Au-26 is a member of the lantibiotic class of peptide antibiotics--the first reported to be produced by a S. aureus strain. Primary sequence analysis showed that the N-terminus of the molecule is isoleucine, a characteristic also displayed by the lantibiotics nisin, epidermin and gallidermin.

Spectroscopy of methane using a Nd:YAG laser at 1.34 microm

We present measurements of the absorption coefficient of methane in the v(2) + 2v(3) band obtained with a neodymium:yttrium aluminum garnet (Nd:YAG) laser tuned by the use of an intracavity étalon to 7472 cm(-1) (1.3383 microm). The linewidth of the laser was shown to be comparable to that of the pressure-broadened methane feature while the absorption coefficient of methane at 1-atm pressure was measured to be 0.59 m(-1) atm(-1). These basic findings indicate that a practical methane detection system using laser radar (lidar) based on a Nd:YAG laser may be possible.

Caustic ingestion injuries of the upper aerodigestive tract

Few reports have described in detail the injuries that occur to the oral cavity, pharynx, and larynx following caustic ingestion. The role of dynamic radiographic studies to delineate the extent of damage has been minimized. In-depth radiographic analysis of such cases has not, to our knowledge, been previously reported. In order to examine the injuries and functional abnormalities of these sites following caustic ingestion, the records of The Johns Hopkins Swallowing Center were reviewed. Five patients were identified as having significant upper aerodigestive tract caustic injuries. All patients had dysphagia, epiglottis injuries, and incomplete laryngeal protection with aspiration. Four of five had sustained some degree of esophageal stenosis. Also noted were pharyngeal muscle dysfunction, nasopharyngeal regurgitation, tongue fixation, and hypopharyngeal stenosis. Roentgenographic findings are described and illustrated. The multidisciplinary approach to the management and rehabilitation of these patients is discussed.

Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group

OBJECTIVE

To determine which types of fractures have an increased incidence in elderly women with low appendicular bone mass.

DESIGN

Prospective cohort study.

SETTING

Four clinical centers in the United States (Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; Monangehela Valley, Pennsylvania); and one coordinating center in San Francisco, California.

SUBJECTS

Ambulatory, nonblack women (9704) aged 65 years or more who were recruited from population-based listings.

MEASUREMENTS

We measured bone mass at the distal and proximal radius and calcaneus using single-photon absorptiometry. Fractures were verified radiographically. Associations were calculated as age-adjusted hazard ratios (with 95% Cls) per standard deviation decrease in bone mass.

MAIN RESULTS

During a mean follow-up of 2.23 years, 841 nonspinal fractures occurred in 753 women. The risks for fractures of the wrist, foot, humerus, hip, rib, toe, leg, pelvis, hand, and clavicle were significantly related to reduced bone mass (P less than 0.05). These fractures represented 74% of nonspinal fractures. The overall hazard ratio for the occurrence of one or more of these fractures was 1.65 (Cl, 1.49 to 1.82) at the distal radius. In a subsample of the cohort, vertebral fractures were also related to low bone mass. Fractures of the ankle, elbow, finger, and face, however, were not associated with bone mass at any measurement site; the overall hazard ratio for these fractures was 1.12 (Cl, 0.96 to 1.30) at the distal radius.

CONCLUSION

Most types of fractures have an increased incidence in elderly women with low bone mass.