Polymorphisms in the low-density lipoprotein receptor-related protein 5 (LRP5) gene are associated with peak bone mass in non-sedentary men: results from the Odense androgen study

PURPOSE

To investigate the impact of the Ala1330Val (rs3736228, exon 18) and Val667Met (rs4988321, exon 9) polymorphisms of the low-density lipoprotein receptor-related protein 5 (LRP5) gene on peak bone mass in young men.

METHODS

The Odense Androgen Study (OAS) is a population-based study comprising 783 Caucasian men aged 20-30 years. Genotyping was performed using real-time polymerase chain reaction (PCR) or fluorescence polarization. Bone mineral density (BMD) measurements were performed using dual-energy X-ray absorptiometry.

RESULTS

The CC, CT, and TT genotypes in Ala1330Val were found in 75.6%, 21.8%, and 2.6% of the participants, respectively. Similarly, the GG, GA, and AA genotypes of Val667Met were found in 89.7%, 9.8%, and 0.5%, respectively. For the Ala1330Val polymorphism, no significant differences between the genotypes were found regarding BMD in the overall study population. However, when analysis was restricted to non-sedentary men (n = 589), a significant association between the number of T-alleles and BMD in the spine and whole body were found. Each copy of the T-allele changed the Z-score of the spine by (median and 95% confidence interval) -0.21 [95% CI: -0.40; -0.03] (p < 0.02). Analysis suggested an association between the AA genotype in the Val667Met polymorphism and increased body height and decreased BMD of the femoral neck; however, no significant gene-dose effect of the A-allele could be demonstrated in the whole population. When the analysis was restricted to non-sedentary subjects, however, each number of A-alleles was associated with a change in Z-score of -0.26 [95% CI: -0.51; -0.01] (p = 0.04). No further significant results emerged with haplotype analysis.

CONCLUSION

The Ala1330Val and Val667Met polymorphisms in the LRP5 gene are significantly associated with peak bone mass in physically active men.

Population-based reference values for bone mineral density in young men

Population-based reference values for peak bone mass density in Danish men. BMD of total hip (1.078 +/- 0,14 g/cm2) differed significantly from values from National Health and Nutrition Examination Survey III and of total lumbar spine ((1.073 +/- 0.125 g/cm2) differed significantly from Hologic values.

INTRODUCTION

Geographic, ethnic, and socio-economic factors are known to affect bone mineral density (BMD) and peak bone mass significantly. Reference values for male peak bone mass are scarce, and the diagnosis of male osteoporosis often relies on values provided by producers of dual-energy X-ray absorptiometry (DXA) equipment.

METHODS

The aim of the present study was 1) to establish population-based reference values for BMD in young men and 2) to study subgroups based on variables with suspected impact on bone metabolism. We included 783 young Caucasian men aged 20 to 30 years in the Odense Androgen Study (OAS).

RESULTS

Peak BMD was attained within the third decade. Obesity (BMI > 30 kg/m2) was associated with higher BMD. Abuse of anabolic steroids as well as chronic illness was associated with lower BMD. Our population-based reference values for BMD of the total hip (1.078 +/- 0.14 g/cm2) differed significantly from published values from National Health and Nutrition Examination Survey III for non-Hispanic white men, while BMD of total lumbar spine (1.073 +/- 0.125 g/cm2) differed significantly from Hologic reference values.

CONCLUSIONS

Locally derived reference values are important to avoid false positive or false negative findings during work-up in patients evaluated for osteoporosis.

The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures

In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twiceas often in the TGN group compared with the DHS group, however they were not statistically significant. Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors and not by highly specialized hip/trauma surgeons. The TGN may have advantages in selected intertrochanteric fractures.;

Development of a population-based threshold model of conidial germination for analysing the effects of physiological manipulation on the stress tolerance and infectivity of insect pathogenic fungi

Entomopathogenic fungi are being used as biocontrol agents of insect pests, but their efficacy can be poor in environments where water availability is reduced. In this study, the potential to improve biocontrol by physiologically manipulating fungal inoculum was investigated. Cultures of Beauveria bassiana, Lecanicillium muscarium, Lecanicillium longisporum, Metarhizium anisopliae and Paecilomyces fumosoroseus were manipulated by growing them under conditions of water stress, which produced conidia with increased concentrations of erythritol. The time-course of germination of conidia at different water activities (water activity, aw) was described using a generalized linear model, and in most cases reducing the water activity of the germination medium delayed the onset of germination without affecting the distribution of germination times. The germination of M. anisopliae, L. muscarium, L. longisporum and P. fumosoroseus was accelerated over a range of aw levels as a result of physiological manipulation. However, the relationship between the effect of physiological manipulation on germination and the osmolyte content of conidia varied according to fungal species. There was a linear relationship between germination rate, expressed as the reciprocal of germination time, and aw of the germination medium, but there was no significant effect of fungal species or physiological manipulation on the aw threshold for germination. In bioassays with M. anisopliae, physiologically manipulated conidia germinated more rapidly on the surface of an insect host, the melon cotton aphid Aphis gossypii, and fungal virulence was increased even when relative humidity was reduced after an initial high period. It is concluded that physiological manipulation may lead to improvements in biocontrol in the field, but choice of fungal species/isolate will be critical. In addition, the population-based threshold model used in this study, which considered germination in terms of physiological time, also called hydrotime, could have general application in mycology and environmental microbiology.

Radiocaesium (137Cs) in marine mammals from Svalbard, the Barents Sea and the North Greenland Sea

Specific activities of the anthropogenic radionuclide, 137Cs, were determined in marine mammals from Svalbard and the Barents and North Greenland Seas. Muscle samples were collected from 12 polar bears, 15 ringed seals, 10 hooded seals, 7 bearded seals, 14 harp seals, one walrus, one white whale and one blue whale in the period 2000-2003. The mean concentrations (+/-SD) of 137Cs were: 0.72+/-0.62 Bq/kg wet weight (w.w.) for polar bears; 0.49+/-0.07 Bq/kg w.w. for ringed seals; 0.25+/-0.10 Bq/kg w.w. for hooded seals; 0.22+/-0.11 Bq/kg w.w. for bearded seals; 0.36+/-0.13 Bq/kg w.w. for harp seals; 0.67 Bq/kg w.w. for the white whale sample; 0.24 Bq/kg w.w. for the blue whale; and below detection limit for the walrus. Significant differences in 137Cs specific activities between some of the species were found. Ringed seals had higher specific activities than the other seal species in the study. Bearded seals and hooded seals had similar values, which were both significantly lower than the harp seal values. The results in the present study are consistent with previous reported results, indicating low specific activities of 137Cs in Arctic marine mammals in the Barents Sea and Greenland Sea region during the last 20 years. The species specific differences found may be explained by varying diet or movement and distribution patterns between species. No age related patterns were found in specific activities for the two species (polar bears and hooded seals) for which sufficient data was available. Concentration factors (CF) of 137Cs from seawater were determined for polar bears, ringed, bearded, harp and hooded seals. Mean CF values ranged from 79+/-32 (SD) for bearded seals sampled in 2002 to 244+/-36 (SD) for ringed seals sampled in 2003 these CF values are higher than those reported for fish and benthic organisms in the literature, suggesting bioaccumulation of 137Cs in the marine ecosystem.

Trends in utilization of antiepileptic drugs in Denmark

OBJECTIVES

To describe utilization of antiepileptic drugs (AEDs) in Denmark during 1993-2002, with special emphasis on oxcarbazepine, and to assess probable indications for AED use.

MATERIALS AND METHODS

We retrieved prescription data from Odense University Pharmacoepidemiological Database, in Funen County, Denmark (population in 2002: 472,869). Within each calendar year we estimated period prevalence, incidence rate and monotherapy rate. Based on co-medication we defined 'epilepsy' when only AEDs were prescribed, 'pain' with co-prescription of opioids, and 'mood disorder' with co-prescription of antipsychotics or antidepressants.

RESULTS

We identified 15,604 AED users. The prevalence of using AED increased from 9.3 (95% CI, 9-9.5) to 12.1 (11.8-12.4)/1000 persons. The incidence rate increased from 1.4 (1.3-1.6) to 1.7 (1.6-1.9)/1000 personyears. The monotherapy rate was 79-82%. AED use for 'epilepsy' declined by 19.7%, whereas the proportion of 'pain' and 'mood disorder' treatment increased by 11.2% and 8.4% respectively.

CONCLUSIONS

Antiepileptic drug utilization increased during the study period, the increase probably caused by expanding use in areas other than epilepsy.

Club foot

The aetiology of congenital club foot is unclear. Although studies on populations, families and twins suggest a genetic component, the mode of inheritance does not comply with distinctive patterns.

The Odense-based Danish Twin Registry contains data on all 73 000 twin pairs born in Denmark over the last 130 years. In 2002 all 46 418 twins born between 1931 and 1982 received a 17-page questionnaire, one question of which was ‘Were you born with club foot?’ A total of 94 twins answered ‘Yes’, giving an overall self-reported prevalence of congenital club foot of 0.0027 (95% confidence interval (CI) 0.0022 to 0.0034). We identified 55 complete twin pairs, representing 12 monozygotic, 22 dizygotic same sex (DZss), 18 dizygotic other sex (DZos) and three unclassified. Two monozygotic and 2 DZss pairs were concordant. The pairwise concordance was 0.17 (95% CI 0.02 to 0.48) for monozygotic, 0.09 (95% CI 0.01 to 0.32) for DZss and 0.05 (95% CI 0.006 to 0.18) for all dizygotic (DZtot) twins.

We have found evidence of a genetic component in congenital club foot, although non-genetic factors must play a predominant role.

Prevalence of overweight, obesity and physical inactivity in 20- to 29-year-old, Danish men. Relation to sociodemography, physical dysfunction and low socioeconomic status: the Odense Androgen Study

OBJECTIVE

To assess the prevalence of overweight, obesity and physical inactivity in 20- to 29-year-old men and to analyze whether sociodemography, physical dysfunction and low socioeconomic status are independent correlates of obesity and physical inactivity.

DESIGN

Population-based, cross-sectional study.

SUBJECTS

Seven hundred and eighty-three Caucasian, Danish men, aged 20-29 years recruited from 2042 respondents in a questionnaire survey of 3000 men, randomly drawn from the Danish Civil Registration System.

METHODS

Questionnaire, interview and physical examination.

RESULTS

The 783 included men and the 2042 questionnaire respondents matched the background population demographically. The 783 men matched the questionnaire respondents as regards BMI, physical activity, chronic disease, medication, smoking, sociodemography and socioeconomic status. The prevalence of overweight and obesity was 31.7 and 7.9%, respectively (World Health Organization criteria). Using waist circumference (WC) cutoffs of 94 and 102 cm, the prevalence was 16.2 and 10.6%, respectively; 24.4% were physically inactive. BMI and WC increased significantly from age 20 to 29 years. Physical activity decreased significantly with age and correlated inversely with WC, but not with BMI. Occupation, geography, partner status, fatherhood and tobacco exposure were independently related with obesity and physical inactivity. Obesity was also related to musculoskeletal complaints, whereas chronic diseases and low educational level were associated with physical inactivity. Age was not independently related with either outcome.

CONCLUSION

In affluent societies, sociodemographic changes may partly explain the age-related decrease in physical activity and the parallel increase in WC and BMI.

Flame retardants and methoxylated and hydroxylated polybrominated diphenyl ethers in two Norwegian Arctic top predators: glaucous gulls and polar bears

The brominated flame retardants have been subject of a particular environmental focus in the Arctic. The present study investigated the congener patterns and levels of total hexabromocyclododecane (HBCD), polybrominated biphenyls, polybrominated diphenyl ethers (PBDEs), as well as methoxylated (MeO) and hydroxylated (OH) PBDEs in plasma samples of glaucous gulls (Larus hyperboreus) and polar bears (Ursus maritimus) from the Norwegian Arctic. The analyses revealed the presence of total HBCD (0.07-1.24 ng/g wet wt) and brominated biphenyl 101 (< 0.13-0.72 ng/g wet wt) in glaucous gull samples whereas these compounds were generally found at nondetectable or transient concentrations in polar bears. Sum (sigma) concentrations of the 12 PBDEs monitored in glaucous gulls (range: 8.23-67.5 ng/g wet wt) surpassed largely those of polar bears (range: 2.65-9.72 ng/g wet wt). Two higher brominated PBDEs, BDE183 and BDE209, were detected, and thus bioaccumulated to a limited degree, in glaucous gulls with concentrations ranging from < 0.03 to 0.43 ng/g wet wt and from < 0.05 to 0.33 ng/g wet wt, respectively. In polar bear plasma, BDE183 was < 0.04 ng/g wet wt for all animals, and BDE209 was only detected in 7% of the samples at concentrations up to 0.10 ng/g wet wt. Of the 15 MeO-PBDEs analyzed in plasma samples, 3-MeO-BDE47 was consistently dominant in glaucous gulls (sigmaMeO-PBDE: 0.30-4.30 ng/g wet wt) and polar bears (sigmaMeO-PBDE up to 0.17 ng/g wet wt), followed by 4'-MeO-BDE49 and 6-MeO-BDE47. The 3-OH-BDE47, 4'-OH-BDE49, and 6-OH-BDE47 congeners were also detected in glaucous gulls (sigmaOH-PBDE up to 1.05 ng/g wet wt), although in polar bears 4'-OH-BDE49 was the only congener quantifiable in 13% of the samples. The presence of MeO- and OH-PBDEs in plasma of both species suggests possible dietary uptake from naturally occurring sources (e.g., marine sponges and green algae), but also metabolically derived biotransformation of PBDEs such as BDE47 could be a contributing factor. Our findings suggest that there are dissimilar biochemical mechanisms involved in PCB and PBDE metabolism and accumulation/elimination and/or OH-PBDE accumulation and retention in glaucous gulls and polar bears.

Human exposure and internal dose assessments of acrylamide in food

This review provides a framework contributing to the risk assessment of acrylamide in food. It is based on the outcome of the ILSI Europe FOSIE process, a risk assessment framework for chemicals in foods and adds to the overall framework by focusing especially on exposure assessment and internal dose assessment of acrylamide in food. Since the finding that acrylamide is formed in food during heat processing and preparation of food, much effort has been (and still is being) put into understanding its mechanism of formation, on developing analytical methods and determination of levels in food, and on evaluation of its toxicity and potential toxicity and potential human health consequences. Although several exposure estimations have been proposed, a systematic review of key information relevant to exposure assessment is currently lacking. The European and North American branches of the International Life Sciences Institute, ILSI, discussed critical aspects of exposure assessment, parameters influencing the outcome of exposure assessment and summarised data relevant to the acrylamide exposure assessment to aid the risk characterisation process. This paper reviews the data on acrylamide levels in food including its formation and analytical methods, the determination of human consumption patterns, dietary intake of the general population, estimation of maximum intake levels and identification of groups of potentially high intakes. Possible options and consequences of mitigation efforts to reduce exposure are discussed. Furthermore the association of intake levels with biomarkers of exposure and internal dose, considering aspects of bioavailability, is reviewed, and a physiologically-based toxicokinetic (PBTK) model is described that provides a good description of the kinetics of acrylamide in the rat. Each of the sections concludes with a summary of remaining gaps and uncertainties.

Significantly higher adrenocorticotropin-stimulated cortisol and 17-hydroxyprogesterone levels in 337 consecutive, premenopausal, caucasian, hirsute patients compared with healthy controls

OBJECTIVE

To investigate whether elevated ACTH-stimulated 17-hydroxyprogesterone (17OHP) levels are caused by CYP21 genetic defects or by a general adrenal hyperresponsiveness in hirsute patients.

METHODS

A total of 337 hirsute patients were evaluated by Ferriman-Gallwey score, serum testosterone, ACTH-stimulated 17OHP, and cortisol during the follicular phase. A cutoff value of 16 nmol/liter for maximum ACTH-stimulated 17OHP (M17OHP) responses was defined as the upper limit of the 95% confidence interval (CI) for the 97.5 percentile in 42 female controls. All patients were offered total screening of the CYP21 gene, and 252 healthy, premenopausal women with regular menses underwent genetic screening.

RESULTS

Patients were divided into idiopathic hirsutism (IH) (n = 180) and polycystic ovary syndrome (PCOS) (n = 157) groups. M17OHP levels were significantly higher in IH [geometric mean value (nmol/liter +/- 2 sd) 12.2 (4.6-32.3)] and PCOS [11.9 (5.3-27.2)] compared with controls [8.5 (5.1-14.2)] (P < 0.001). A similar percentage of IH and PCOS patients had elevated M17OHP (20.5 vs. 20.8%, not significant), and these also had significantly higher 30-min cortisol levels compared with controls (P < 0.05). The prevalence of CYP21 mutations in patients was 8.6% compared with 6.3% in controls (P = 0.38). Ten of 19 carriers had M17OHP levels below the cutoff limit.

CONCLUSION

The significantly higher ACTH-stimulated levels of cortisol and 17OHP in hirsute patients indicated adrenal hyperresponsiveness in IH and PCOS. CYP21-carrier status could not explain the observed high prevalence of abnormal ACTH-stimulated 17OHP levels in the hirsute population.

Morphometric X-ray absorptiometry: reference data for vertebral dimensions in a population-based sample of young Danish men

PURPOSE

To determine reference values for vertebral heights in healthy young Danish males using morphometric X-ray absorptiometry (MXA).

MATERIAL AND METHODS

A population-based study group of 487 males aged between 20 and 30 years (mean 25 years) from the county of Funen, Denmark, were recruited. Using a Hologic QDR 4500 (dual energy X-ray absorptiometry) DXA-scanner, MXA scans covering the vertebrae from T4 to L4 were acquired for each subject. Anterior (Ha), middle (Hm), and posterior (Hp) heights of the thoracic (T4-T12) and lumbar (L1-L4) vertebral bodies were measured. Moreover, wedge, mid-wedge, crush I, and crush II ratios were calculated.

RESULTS

No correlation between vertebral dimensions and crush indices on the one hand and age or weight on the other were found. Body height, however, correlated significantly with the cumulated vertebral heights. Reference data for vertebral dimensions, wedge, mid-wedge, crush I, and crush II are tabulated.

CONCLUSION

The anterior, middle, and posterior heights of the vertebral bodies of T4 to L4 can be measured reproducible with MXA. In young men, the cumulative vertebral heights correlated with body height but not with age. Moreover, the wedge and crush indices were unrelated of both age and height.

Incisional local anaesthesia versus placebo for pain relief after appendectomy in children--a double-blinded controlled randomised trial

Incisional local anaesthesia is widely used for postoperative pain relief after surgery. We present the results of a double-blinded and randomised controlled study of incisional bupivacaine versus placebo in 68 children undergoing open appendectomy. The trial medicine (0.5 ml/kg) was infiltrated into the subcutis after wound closure. Patients with a weight below 40 kg received a bupivacaine concentration of 0.25 % and the patients above 40 kg a concentration of 0.5 %. During the first 24 hours after surgery the patients in the bupivacaine group received on average 0.065 mg morphine/kg and in the placebo group 0.073 mg/kg. This difference was not statistically significant. The patients in the bupivacaine group tended to experience pain relief for a longer period of time compared to the patients in the placebo group. However, the difference was not significant. In conclusion, the use of subcutaneous infiltration with bupivacaine in the wound after open appendectomy had no significant effect on the use of morphine during the first postoperative day in children.

Carers' perceptions of pain in people with dementia: a grounded theory approach

The purpose of this Grounded Theory based study was to add to the limited understanding about the perception and observation of pain by the formal and informal carers of people with dementia. Thirty-one carers talked about how they know when their person with dementia has pain. Findings showed there is no one set of signs or behaviours that indicate pain in all people with dementia. However, a common pain assessment process amongst carers involved being able to detect deviation from normal behaviours based upon their intimate knowledge of what is normal for their person. A central hypothesis was thus generated from the data that considered that effective pain assessment for people with dementia is dependent on carers having an intimate knowledge of the individual's normal state of being with dementia. Implications for nursing practice are discussed.