Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study

In a study of 2005 institutionalized older people, use of oral bisphosphonates was associated with a 27% reduction in risk of death compared to non-users after adjusting for potential confounders.

INTRODUCTION

This study investigated whether reductions in mortality reported in a trial of intravenous zoledronate after hip fracture could be seen in older people taking oral bisphosphonates.

METHODS

Two thousand and five institutionalized older people (mean age 85.7 years) were assessed at baseline and followed up for hip fracture and death for at least 5 years. Cox proportional hazards regression was used to estimate effects of bisphosphonates on risk of death.

RESULTS

At baseline, 78 subjects were taking oral bisphosphonates. Over 5 years of follow-up, 1,596 participants (80%) died. Use of bisphosphonates was associated with a 27% reduction in risk of death compared to non-users after adjusting for age, gender, type of institution, immobility, number of medications, weight, cognitive function, co-morbidities, and hip fracture incidence during the follow-up period (hazard ratio 0.73; 95% CI, 0.56 to 0.94; P = 0.02).

CONCLUSION

Oral bisphosphonates are associated with a reduction in the risk of death in the elderly. The mechanism of effect requires further investigation.

Nanostructured SmCo5 thin films with perpendicular anisotropy formed in a wide range of Sm-Co compositions

In this work, we prepared SmCo5 thin films with (0001) texture exhibiting perpendicular anisotropy in a wide range of Sm(x)Co(100-x) compositions (x = 13.2 approximately 37.0) on Cu/Ta underlayers. At a composition of Sm16.7Co83.3 (SmCo5), the SmCo5 film exhibits a maximum perpendicular coercivity of 18.2 kOe, which is attributed to a good crystallinity and an excellent (000l) texture. The SmCo5 (000l) peaks are shifted to smaller angles compared to the standard powder sample which indicates the formation of a SmCoCu alloy through Cu diffusion. The EDX result for this sample gives a composition of SmCo3Cu2.1 which confirms Cu diffusion into the SmCo5 layer. TEM image shows that SmCo5 film is well crystallized with a grain size of 50 nm.

Nanogranular L1(0) FePt-C-Ta2O5 composite media for perpendicular recording applications

In this report, the effect of simultaneously adding two dopants (C and Ta2O5) in FePt was investigated. (Fe55Pt45)79C21-(x vol%) Ta2O5 films (where x = 0% to 20%) were prepared using both low and high power magnetron sputtering on MgO (2 nm)/CrRu (30 nm) underlayers with in-situ heating at 350 degrees C. Films deposited at low power showed a decrease in exchange coupling with increasing Ta2O5 content. Out-of-plane coercivity of 7.2 kOe was observed even with up to 20 vol% Ta2O5. X-Ray diffraction spectra showed presence of FePt(001) texture for all compositions of Ta2O5 ranging from 0 to 20 vol% suggesting that the perpendicular anisotropy was maintained even with up to 20 vol% of dopant content. Films deposited at high power showed a different behavior with an initial increase in out-of-plane coercivity to 8.2 kOe and a reduction in exchange coupling with loop slope parameter (alpha) approaching a fully decoupled value of 1. Further increase in doping content led to deterioration in the out-of-plane coercivity, as well as an increase in the exchange coupling.

Interlayer exchange coupling effect of L1(0) CoPt based exchange coupled composite media

In this work, effects of exchange coupling of soft magnetic layer on switching field and magnetization reversal behaviour of CoPt-SiO2(soft)/CoPt-SiO2(hard) exchange coupled media were investigated. With increasing the thickness of the soft layer, both the coercivity and magnetization squareness of composite media decreased. Soft layer thickness 4 nm and below was more effective to significantly reduce the switching field than that above 4 nm. More incoherent switching behavior was observed with increasing soft layer thickness.

NiW/Ru underlayer for CoPt-SiO2 granular perpendicular recording media

This paper presented the usage of the NiW/Ru underlayer to replace the single Ru underlayer for promoting CoPt hcp (0002) texture. Fcc (111) textured NiW film was used to induce the Ru hcp (0002) texture. It was found that the utilization of the (111) textured NiW alloying layer promoted the formation of Ru(0002) texture, enhanced the magnetic grain isolation and generated the uniform grains with gain size less than 10 nm in CoPt-SiO2 recording layer. The out-of-plane coercivity was also enhanced with the growth of 10 nm NiW underlayer below the Ru layer.

Effects of ulinastatin and cyclophosphamide on the growth of xenograft breast cancer and expression of CXC chemokine receptor 4 and matrix metalloproteinase-9 in cancers

The aim of this study was to evaluate the effects of ulinastatin (UTI) and cyclophosphamide (CTX) as mono therapies and as combination therapy on the growth of mouse xenograft breast tumours. MCF-7 breast cancer cells were xenografted into 48 nu/nu nude mice in order to construct a breast cancer xenograft nude mouse model; mice were then untreated (control), or treated with CTX 0.1 g/kg every other day, UTI once a day at 25 000 U (low), 50 000 U (medium) or 100 000 U (high), or CTX + UTI (low), CTX + UTI (medium) or CTX + UTI (high) (n = 6 mice/group). Compared with controls, mice in each drug-treated group had a significantly reduced tumour weight, and protein and mRNA levels of CXC chemokine receptor 4 and matrix metalloproteinase-9 in both the UTI (low, medium and high doses) and CTX groups were significantly reduced, while levels in the UTI (low, medium and high doses) + CTX combination groups were significantly reduced compared with the CTX group and the UTI (low, medium, high) groups. Thus, both UTI and CTX can significantly inhibit xenograft tumours, and the UTI + CTX combination exhibited an additive effect that was superior to both CTX and UTI monotherapy.

Axonal growth from insect neurons in glia-free cultures

Mechanical dissociation of nerve and glial cells from 16-day embryos of the cockroach Periplaneta americana and their subsequent culture in a Co(2)-conditioned, chemically defined medium results in the survival of neurons but not of glial cells. The dissociated nerve cells remain alive and in excellent condition for many months and build a dense fibrillar network in presence of foregut explants from the same embryos. These explants are invaded by numerous and large fiber bundles emerging from the fibrillar network. The morphological characteristics of nerve cells and the structural and ultrastructural features of nerve bundles in long-term glia-free culture are described.

Mutation analysis of the APC gene in Taiwanese FAP families: low incidence of APC germline mutation in a distinct subgroup of FAP families

Familial adenomatous polyposis (FAP) is an autosomal-dominant disease caused by germline mutations in the adenomatous polyposis coli (APC) gene. The affected individuals develop colorectal polyposis and show various extra-colonic manifestations. In this study, we aimed to investigate the genetic and clinical characteristics of FAP in Taiwanese families and analyze the genotype-phenotype correlations. Blood samples were obtained from 66 FAP patients registered in the hereditary colorectal cancer database. Then, germline mutations in the APC genes of these 66 polyposis patients from 47 unrelated FAP families were analyzed. The germline-mutation-negative cases were analyzed by performing multiplex ligation-dependent probe amplification (MLPA) and single-strand conformation polymorphism (SSCP) analysis of the MUTYH gene. Among the analyzed families, 79% (37/47) of the families showed 28 APC mutations, including 19 frameshift mutations, 4 nonsense mutations, 3 genomic deletion mutations, 1 missense mutation, and 1 splice-site mutation. In addition, we identified 15 novel mutations in 32% (15/47) of the families. The cases in which APC mutations were not identified showed significantly lower incidence of profuse polyposis (P = 0.034) and gastroduodenal polyps (P = 0.027). Furthermore, FAP families in which some affected individuals had less than 100 polyps showed significant association with low incidence of APC germline mutations (P = 0.002). We have added the APC germline-mutation data for Taiwanese FAP patients and indicated the presence of an FAP subgroup comprising affected individuals with nonadenomatous polyps or less than 100 adenomatous polyps; this form of FAP is less frequently caused by germline mutations of the APC gene.

Selective Enrichment of Hepatocellular Cancer Stem Cells by Chemotherapy

This study investigated the enrichment of cancer stem cells (CSCs) in hepatocellular carcinoma (HCC) by chemotherapy. SMMC-7721 cells were inoculated into mice treated with 0, 2, 5 or 10 mg/kg cyclophosphamide (CTX). Tissue from the resulting tumours was re-inoculated into CTX-treated mice two more times, thus producing three generations of tumour cells for each dose of CTX. Chromosome and fluorescence-activated cell sorting analyses were performed to determine the purity of the enriched cells. Sphere culture, colony formation and proliferation assays demonstrated that the self-renewal potential, proliferative activity and clonogenicity of the enriched cells in vitro increased with increasing chemotherapy dose and generation. The ability of the enriched cells to produce xenograft tumours in mice was also dependent on chemotherapy dose and generation. In conclusion, subjecting HCC cells to chemotherapy in vivo enriched the samples for HCC CSCs in a dose-and generation-dependent manner.

Management of osteoporosis in primary care in Australia

This study reviewed factors influencing osteoporosis management in primary care settings in Australia and examined risk profiles of patients (n = 37,957) for osteoporosis. Only 29.7% of patients with a prior fracture were currently on specific medication for osteoporosis. The results highlight the need for further exploration of barriers to osteoporosis management.

INTRODUCTION

Osteoporosis management in primary care is suboptimal even for high-risk people with a history of prior fracture.

METHODS

This study reviewed factors influencing the management of individuals at risk for osteoporosis in primary care settings in Australia and examined risk profiles of patients for osteoporosis. Patients (n = 37,957, mean age 71) were recruited over a 12-month period (February 2006-Jan 2007) and interviewed.

RESULTS

With regard to risk factors for osteoporosis, 12.6% of patients reported a history of prior minimal trauma fracture, 7.5% reported a family history of osteoporosis, 7.4% reported they were current smokers, 11.4% reported low dietary calcium intake, 31.8% reported no regular weekly physical exercise and 10.3% reported current use of glucocorticoids. Of those with a prior fracture, only 29.7% were currently on specific medication for osteoporosis. Radiography (n = 17,754) demonstrated a prior vertebral fracture in 30.1%, but only 3.8% of the 17,754 patients reported current use of specific osteoporosis medication.

CONCLUSIONS

This study has confirmed low rates of treatment in primary care even in individuals who have already suffered a prior fracture or have other risk factors. This study highlights the need for further exploration of barriers to osteoporosis management in the primary care setting.

A large chest wall tumour in an asymptomatic 15-year-old girl

A 15-year-old asymptomatic girl was found to have a large left lower chest wall mass associated with chest wall invasion on an opportunistic chest radiograph. The tumour was excised and shown to be a clear cell sarcoma. Adjuvant chemotherapy was administered and she was disease free at her 10 month follow up.

Role of quantitative ultrasound to predict fracture among institutionalised older people with a history of fracture

The fracture predictive value of quantitative ultrasound (QUS) may be modified by previous fracture status. Non-significant associations between QUS parameters and fracture risk were observed among frail older people with a history of fracture. These findings suggest that QUS measurements for frail older people might be more useful in those without a fracture history.

INTRODUCTION

Quantitative ultrasound has been shown to predict risk of fracture in various populations. However, this ability may be modified by the presence of previous fracture in very frail older people.

METHODS

We assessed bone strength by QUS and clinical risk factors at baseline for 1,982 institutionalised older people. Fractures were ascertained for 2 years from baseline and validated by X-ray reports.

RESULTS

Study participants were very old (mean age = 85.7 +/- 7.1 years) and frail (70% using walking aids). Forty-five percent reported a history of fracture. During a mean follow-up period of 1.64 years, 335 participants suffered a fracture or fractures. Fracture rates were significantly higher in participants with a history of fracture compared with those without a history of fracture (16.0 vs 9.2 per 100 person years, p < 0.001). Significant associations between fracture risk and QUS parameters (broadband ultrasound attenuation and velocity of sound) were observed among participants without a history of fracture (both p < 0.01), but not among those who had a fracture history (both p >/= 0.7).

CONCLUSIONS

In very frail older people, QUS measurements may be more useful for assessing fracture risk in those without a history of fracture after age 50.

Melittin-induced [Ca2+]i increases and subsequent death in canine renal tubular cells

The effect of melittin on cytosolic free Ca2+ concentration ([Ca2+]i) and viability is largely unknown. This study examined whether melittin alters Ca2+ levels and causes Ca2+-dependent cell death in Madin-Darby canine kidney (MDCK) cells. [Ca2+]i and cell death were measured using the fluorescent dyes fura-2 and WST-1 respectively. Melittin at concentrations above 0.5 μM increased [Ca2+]i in a concentration-dependent manner. The Ca2+ signal was reduced by 75% by removing extracellular Ca2+. The melittin-induced Ca2+ influx was also implicated by melittin-caused Mn2+ influx. After pretreatment with 1 μM thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor), melittin-induced Ca2+ release was inhibited; and conversely, melittin pretreatment abolished thapsigargin-induced Ca2+ release. At concentrations of 0.5–20 μM, melittin killed cells in a concentration-dependent manner. The cytotoxic effect of 0.5 μM melittin was nearly completely reversed by prechelating cytosolic Ca2+ with BAPTA. Melittin at 0.5–2 μM caused apoptosis as assessed by flow cytometry of propidium iodide staining. Collectively, in MDCK cells, melittin induced a [Ca2+]i rise by causing Ca2+ release from endoplasmic reticulum and Ca2+ influx from extracellular space. Furthermore, melittin can cause Ca2+-dependent cytotoxicity in a concentration-dependent manner.

Mismatch repair protein expression in Amsterdam II criteria-positive patients in Taiwan

BACKGROUND

Hereditary non-polyposis colorectal cancer (HNPCC) is characterized genetically by germline mutations in DNA mismatch repair (MMR) genes. Immunohistochemistry (IHC) has high sensitivity and specificity for identifying MMR-deficient tumours. This study investigated the clinical presentations and frequency of HNPCC in Taiwan by combined Amsterdam II criteria (AC-II) and IHC.

METHODS

In 1995-2003, 7108 patients with primary colorectal cancer registered in Chang Gung Memorial Hospital's Colorectal Cancer Registry were screened using AC-II. Tumour specimens were analysed for MMR protein expression by IHC, and relevant clinicopathological details were documented.

RESULTS

Some 83 patients fulfilled the AC-II. Clinicopathologically, 43 patients (52 per cent) had proximal tumours, ten (12 per cent) had poorly differentiated cancers, 17 (20 per cent) had mucinous adenocarcinoma and 51 (61 per cent) had stage I-II tumours. Seventeen patients developed second primary colonic and extracolonic cancers over a mean 7.2-year follow-up. Immunohistochemically, 58 patients were MMR protein deficient. They had a significantly earlier age of onset (P < 0.001), more proximal tumour location (P = 0.002), less advanced tumour stage (P = 0.008) and more second primary cancers (P = 0.017) compared with MMR-competent patients.

CONCLUSION

These data show significant differences in clinical features between MMR protein-deficient and MMR competent subgroups.

First Report of Soft Rot Caused by Pectobacterium carotovorum on Pinellia ternata in China

Pinellia ternata (Thumb.) Breit. (Araceae) is a traditional herb used as an antivomit, anticough, analgesic, and sedative in China for more than 1,000 years. From the summer through fall of 2003 to 2005, a high incidence (approximately 10 to 25%) of disease outbreaks characterized by water-soaked lesions and soft rot with a stinky odor were observed in the cultivated P. ternata in Shanxi Province. Water-soaked lesions were first observed on the stem base and then the plant collapsed, although the upper portion remained asymptomatic. Subsequently, the lesions expanded rapidly over the entire plant. The macerated tuber was usually reduced to a whitish, mushy, and foul-smelling pulp surrounded by undecayed periderm. A Pectobacterium species was consistently recovered from the diseased tubers on nutrient agar media. Koch's postulates were completed by stab inoculating 6-week-old peach- and willow-leaved P. ternata cultivars with the bacterial suspensions (1 × 10⁸ CFU/ml) (1). Ten control plants for each cultivar were inoculated with sterile water. After inoculation, plants were maintained in a growth chamber at 25°C with relative humidity ranging from 80 to 90%. After 2 to 3 days, typical soft rot symptoms were observed on the inoculated plants. A Pectobacterium species was reisolated from the symptomatic tubers while control plants remained healthy. This experiment was repeated in May, July, and September. The pathogenic isolates were identified as typical Pectobacterium carotovorum on the basis of morphological, physiological, and biochemical characteristics (2). The Microlog system (version 3.5; Biolog, Hayward, CA) and Sherlock Microbial Identification System (version 4.5; MIDI Newark, DE) also identified them as Pectobacterium carotovorum on the basis of similarity indices more than 66.9 and 78.2%, respectively. Their identity was then confirmed by sequencing the gene encoding the 16S rRNA (GenBank Accession No DQ785511). To our knowledge, this is the first report of Pectobacterium carotovorum as the cause of soft rot of P. ternata. References: (1) H. R. Azad et al. Plant Dis.84:973, 2000. (2) L. Hauben et al. Syst. Appl. Microbiol. 21:384, 1998.

A novel amperometric biosensor based on ZnO:Co nanoclusters for biosensing glucose

ZnO:Co nanoclusters were synthesized by nanocluster-beam deposition with averaged particle size of 5 nm and porous structure, which were for the first time adopted to construct a novel amperometric glucose biosensor. Glucose oxidase was immobilized into the ZnO:Co nanocluster-assembled thin film through Nafion-assisted cross-linking technique. Due to the high specific active sites and high electrocatalytic activity of the ZnO:Co nanoclusters, the constructed glucose biosensor showed a high sensitivity of 13.3 microA/mA cm2. The low detection limit was estimated to be 20 microM (S/N=3) and the apparent Michaelis-Menten constant was found to be 21 mM, indicating the high affinity of the enzyme on ZnO:Co nanoclusters to glucose. The results show that the ZnO:Co nanocluster-assembled thin films with nanoporous structure and nanocrystallites have potential applications as platforms to immobilize enzyme in biosensors.

Molecular cloning, nucleotide sequencing, and expression of genes encoding alcohol dehydrogenases from the thermophile Thermoanaerobacter brockii and the mesophile Clostridium beijerinckii

Proteins play a pivotal role in thermophily. Comparing the molecular properties of homologous proteins from thermophilic and mesophilic bacteria is important for understanding the mechanisms of microbial adaptation to extreme environments. The thermophile Thermoanaerobacter (Thermoanaerobium) brockii and the mesophile Clostridium beijerinckii contain an NADP(H)-linked, zinc-containing secondary alcohol dehydrogenase (TBADH and CBADH) showing a similarly broad substrate range. The structural genes encoding the TBADH and the CBADH were cloned, sequenced, and highly expressed in Escherichia coli. The coding sequences of the TB adh and the CB adh genes are, respectively, 1056 and 1053 nucleotides long. The TB adh gene encoded an amino acid sequence identical to that of the purified TBADH. Alignment of the deduced amino acid sequences of the TB and CB adh genes showed a 76% identity and a 86% similarity, and the two genes had a similar preference for codons with A or T in the third position. Multiple sequence alignment of ADHs from different sources revealed that two (Cys-46 and His-67) of the three ligands for the catalytic Zn atom of the horse-liver ADH are preserved in TBADH and CBADH. Both the TBADH and CBADH were homotetramers. The substrate specificities and thermostabilities of the TBADH and CBADH expressed inE. coli were identical to those of the enzymes isolated from T. brockii and C. beijerinckii, respectively. A comparison of the amino acid composition of the two ADHs suggests that the presence of eight additional proline residues in TBADH than in CBADH and the exchange of hydrophilic and large hydrophobic residues in CBADH for the small hydrophobic amino acids Pro, Ala, and Val in TBADH might contribute to the higher thermostability of the T. brockii enzyme.

Indiscernible benefit of high-resolution HLA typing in improving long-term clinical outcome of unrelated umbilical cord blood transplant

The success of allogeneic hematopoietic stem cell transplantation depends in part on the accuracy of human leukocyte antigen (HLA) matching between the donor-recipient pair. The higher the number of matching HLA alleles, the smaller the chance that the transplant recipient will develop complications. Umbilical cord blood (UCB) transplantation was noted to result in a remarkably low frequency and severity of graft-versus-host disease (GvHD) and graft rejection compared to that in unrelated bone marrow transplant recipients. At present most banks match UCB donors for respective recipients by HLA-A, -B low-resolution typing and -DRB1 high-resolution typing. We retrospectively conducted high-resolution sequence-based HLA typing on DNA samples available from 65 Chinese UCB-recipient pairs typed previously by using low-resolution sequence-specific oligonucleotide probes and sequence-specific primers, and evaluated the clinical outcome. High-resolution typing revealed imperceptible HLA alleles that were hardly identified in low-resolution typing. Univariate analyses demonstrated no significant correlation between the extents of high-resolution HLA disparity with engraftment, graft failure, acute GvHD, transplant-related mortality and long-term 6-year overall survival. Data from the study suggest that high-resolution typing for HLA-A, -B and -DRB1 contributed no substantial improvement to UCB transplant outcome. Low-resolution typing appears to be amenable to matching UCB-recipient pairs without compromising the quality of transplant.

Influence of fall related factors and bone strength on fracture risk in the frail elderly

INTRODUCTION

When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective. In a prospective study of elderly subjects at high risk of falls, we investigated the influence of bone strength and fall risk on fracture.

METHODS

At baseline we assessed calcaneal bone ultrasound attenuation (BUA) as well as quantitative measures of fall risk in 2005 subjects in residential care. Incident falls and fractures were recorded (median follow-up 705 days).

RESULTS

A total of 6646 fall events and 375 low trauma fracture events occurred. The fall rate was 214 per 100 person years and the fracture rate 12.1 per 100 person years. 82% of the fractures could be attributed to falls. Although fracture rates increased with decreasing BUA (incidence rate ratio 1.94 for lowest vs. highest BUA tertile, p<0.002), incident falls also affected fracture incidence. Subjects who fell frequently (>3.15 falls/per person year) were 3.35 times more likely to suffer a fracture than those who did not fall. Some fall risk factors such as balance were associated with the lowest fracture risk lowest in the worst performing group. Multivariate analysis revealed higher fall rate, history of previous fracture, lower BUA, lower body weight, cognitive impairment and better balance as significant independent risk factors for fracture.

CONCLUSIONS

In the frail elderly, both skeletal fragility and fall risk including the frequency of exposure to falls are important determinants of fracture risk.

Banking and transplantation of umbilical cord blood in Guangzhou, China

BACKGROUND

Umbilical cord blood (UCB) is an alternative source of hematopoietic stem cells (HSC) for transplantation of patients with hematologic malignancies or hereditary diseases.

METHODS

We developed a provincial UCB bank in Guangzhou, China, using good manufacturing practices and standard operating procedures to address donor eligibility, collection, characterization, processing, storage and release from quarantine. The banking activities were analyzed.

RESULTS

From June 1998 to May 2005, 8623 UCB units of Han ethnic origin were collected; 4147 (48.1%) were stored, while 4476 (51.9%) were discarded as a result of pre-determined exclusion criteria. A median volume of 95.5 mL (range 60-227.7) and 1.2 x 10(9) (0.8-9.3) nucleated cells were collected. The cell viability was 97.8% (90-100%). The CD34+ cell count of 3691 (89.0%) UCB units was 5.2 x 10(6) (0.3-131.6) and clonogenic assays of 4036 (97.3%) UCB units demonstrated 9.8 x 10(5) (0.04-135.8) CFU-GM, 0.3 x 10(5) (0.0-18.6) CFU-GEMM and 8.8 x 10(5) (0.0-74.2) BFU-E. A total of 0.4% (15/3863) UCB derived from babies known to have health problems at age 6 months was discarded. Up to May 2005, 151 units were issued for transplantation to 127 patients [90 (70.9%) children and 37 (29.1%) adults]. The infused nucleated cells in unrelated single-unit recipients were 3.4 x 10(7)/kg (1.7-14.9) for adults (n=19) and 5.7 x 10(7)/kg (2.0-20.5) for children (n=71), respectively. The numbers of days for the engraftment of neutrophils among 65 children and 22 adults were 17 (7-41) and 20 (10-42), respectively.

DISCUSSION

Data of this study show that stringent procedures and comprehensive policies are requisite for pursuing the banking and release of quality UCB for successful transplantation.

Restricted diffusion in bilateral optic nerves and retinas as an indicator of venous ischemia caused by cavernous sinus thrombophlebitis

A 44-year-old man developed bilateral blindness following severe periorbital cellulitis and pansinusitis. CT and MR imaging demonstrated bilateral cavernous sinus thrombosis. Diffusion-weighted imaging revealed reduced apparent diffusion coefficient in bilateral optic nerves, suggesting optic nerve ischemia caused by the cavernous sinus thrombophlebitis (CST). Following surgical debridement of pansinusitis, antimicrobial therapy, and anticoagulation, the patient recovered from the infectious episode but sustained permanent bilateral blindness. This case shows that both retinal and optic nerve ischemia can be the cause of blindness after CST. Arguments supporting an arterial-versus-venous origin for the ischemia are discussed.

Calcaneal ultrasound but not bone turnover predicts fractures in vitamin D deficient frail elderly at high risk of falls

BACKGROUND

Biochemical markers of bone turnover have been reported to predict fracture risk independent of bone mass in postmenopausal women. We investigated their use in predicting fractures in the frail elderly.

METHODS

Cases were 151 low trauma fractures. For each case, a control was selected marched for sex, age, institution type and follow-up period. We measured two bone resorption markers (serum ICTP and serum CTX-I) and two bone formation markers (serum PINP and serum BAP). Quantitative Ultrasound (QUS) was measured in the calcaneus. Fractures were ascertained by x-ray reports.

RESULTS

The mean age of subjects was 86.8 years (+/- 5.8 SD) and 86% were female. 76% had hypovitaminosis D (a serum 25 hydroxy vitamin D (25OHD) level < 39 nmol/L) and 81% had BUA < 67.4 dB/MHz (corresponding to a BMD T-score < -2.5). No significant differences in bone turnover markers were detected between fracture cases and their matched controls. In contrast, there was a significant difference between cases and controls for both broadband ultrasound attenuation (BUA) and velocity of sound (VOS) (both P < 0.05). These results remained the same after adjusting for weight, lower leg length and walking aids as well as the higher falls incidence in cases than controls (average 2.7 vs 0.9 falls respectively; P < 0.001) during the follow-up period.

CONCLUSION

In the frail elderly with vitamin D deficiency and high falls risk, calcaneal ultrasound but not markers of bone turnover were associated with fractures.

Polarization modulation instability in photonic crystal fibers

Polarization modulation instability (PMI) in birefringent photonic crystal fibers has been observed in the normal dispersion regime with a frequency shift of 64 THz between the generated frequencies and the pump frequency. The generated sidebands are orthogonally polarized to the pump. From the observed PMI frequency shift and the measured dispersion, we determined the phase birefringence to be 5.3 x 10(-5) at a pump wavelength of 647.1 nm. This birefringence was used to estimate the PMI gain as a function of pump wavelength. Four-wave mixing experiments in both the normal and the anomalous dispersion regimes generated PMI frequency shifts that show good agreement with the predicted values over a 70 THz range. These results could lead to amplifiers and oscillators based on PMI.