Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial

BACKGROUND: The efficacy of antiresorptive therapy in preventing fractures in women at highest fracture risk, such as very elderly women or those with severe osteoporosis, is uncertain. PARTICIPANTS AND METHODS: Using data from a double-blind, randomized, placebo-controlled clinical trial that enrolled 2027 postmenopausal women aged 55 to 81 years with low femoral neck bone mineral density (BMD) and existing vertebral fractures, we examined the consistency of the effect of treatment with alendronate sodium in preventing fractures within a priori-specified risk subgroups defined at baseline by age, bone density, number of preexisting vertebral fractures, and history of postmenopausal fracture. The women were randomized to oral administration of alendronate or placebo and followed up for an average of 2.9 years. The initial dose of alendronate sodium was 5 mg/d; the dosage was increased from 5 to 10 mg/d at 24 months. New vertebral fractures, the primary end point of this arm of the trial, were defined by morphometry as a decrease of 20% and at least 4 mm in any vertebral height between baseline and a follow-up radiograph at 36 months. Incident clinical fractures, the secondary end point, included nonspine and clinical (symptomatic) vertebral fractures. All clinical fractures were confirmed with x-ray film reports or, in the case of clinical vertebral fractures, x-ray films. RESULTS: Overall, there was a 47% significant reduction in risk of new vertebral fractures in the alendronate group compared with the placebo group. The reduction in risk of new vertebral fracture was consistent across fracture risk categories including age (relative risk [RR], 0.49 in women < 75 years compared with 0.62 in those > or = 75 years), BMD (RR, 0.54 in women with a femoral neck BMD < 0.59 g/cm2 [median] compared with 0.53 in those with a BMD > or = 0.59 g/cm2), and number of preexisting vertebral fractures (RR, 0.58 in women with 1 vertebral fracture compared with 0.52 in those with > or = 2). The overall significant 28% reduction in risk of incident clinical fractures in the alendronate group compared with the placebo group was also observed within these subgroups. Compared with the number of lower-risk women, a similar or smaller number of high-risk women needed to be treated to prevent 1 fracture. For example, 8 women aged 75 years or older compared with 9 women younger than 75 years, or 4 women with 2 or more existing vertebral fractures compared with 16 women with 1 existing vertebral fracture, needed to be treated with alendronate for 5 years to prevent 1 new vertebral fracture. CONCLUSIONS: Alendronate effectively reduces fracture risk in postmenopausal women with vertebral fractures and low BMD, including those women at highest risk because of advanced age or severe osteoporosis. Since the risk reductions observed with alendronate treatment were consistent within fracture risk categories, more fractures were prevented by treating women at highest risk.     

Effects of plant community composition and exposure to wave action on invertebrate habitat use of Lake Huron coastal wetlands

Invertebrate communities from different coastal marsh‐plant communities were compared along wave‐exposure gradients using data from 1994, 1998 and 1999. Data were subjected to correspondence analyses to search for patterns in invertebrate communities in relation to plant‐community structure and wave exposure. In 1994, quantitative plant‐ and sediment‐invertebrate samples were taken from nine habitats: four from inland, subsurface‐connected marshes and five from littoral, emergent marshes. In 1998, sweep‐net samples were taken from 13 plant communities: six on the exposed and seven on the protected side of an island. In 1999, 2–3 plant communities/sites were sampled with sweep nets from four sites around the Bay so that intersite differences between inner, less‐exposed and outer, more‐exposed habitats could be examined. In all three studies, correspondence analyses separated inland, protected or inner sites from littoral, exposed or outer sites, suggesting differences in invertebrate‐community structure. For example, Hydracarina and Asellidae occurred in large numbers in inland sites, but were less common or absent from exposed, littoral sites. Littoral marshes also separated along an exposure gradient with Tanytarsini and Orthocladiinae collectors of organic particles occurring in very high numbers in outer, exposed areas where organic particles from the pelagic zone entered the marsh. Certain plant‐community types clustered together (e.g. wet meadow and Scirpus) while others, such as Typha, stands clustered according to exposure to waves suggesting the importance of both plant‐community structure and wave exposure in determining invertebrate‐community structure. We present a conceptual model that suggests that invertebrates in Great Lakes' marshes are distributed along gradients of decreased mixing of pelagic water and increases in sediment organic matter from outer to inner marsh and between littoral and adjacent inland marshes. Some invertebrates do best on one end of these gradients, while the majority are generalists found across habitat types.     

The infrared infiltration and joining of advanced material

JOM - Infrared processing is a newly developed technique for materials processing. Key features include rapid processing, simplicity, and low cost. Because of the rapid processing, very little...     

Laparoscopic cholecystectomy in pancreas transplant recipients

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Since its introduction in 1987, this procedure has been employed with increasing frequency as its safety has been documented in numerous studies. Absolute contraindications to laparoscopic cholecystectomy have become relative contraindications, and patients previously felt to be at excessive risk for laparoscopic cholecystectomy are viewed as patients who may benefit from laparoscopic cholecystectomy. The use of this procedure in patients with comorbid medical conditions has the potential to decrease patient morbidity. Patients who have previously undergone solid organ transplantation and require immunosuppressive therapy are a group of patients who may benefit from laparoscopic cholecystectomy. We report four patients who have previously undergone combined renal and pancreas transplantation who underwent successful laparoscopic cholecystectomy.     

Heuristics for rapidly four-coloring large planar graphs

We present several algorithms for rapidly four-coloring large planar graphs and discuss the results of extensive experimentation with over 140 graphs from two distinct classes of randomly generated instances having up to 128,000 vertices. Although the algorithms can potentially require exponential time, the observed running times of our more sophisticated algorithms are linear in the number of vertices over the range of sizes tested. The use of Kempe chaining and backtracking together with a fast heuristic which usually, but not always, resolves impasses gives us hybrid algorithms that: (1) successfully four-color all our test graphs, and (2) in practice run, on average, only twice as slow as the well-known, nonexact, simple to code, Θ(n) saturation algorithm of Brélaz.     

Multifactorial assessment of bulimia nervosa.

Investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. 245 bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing unidimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Noncontact knee dislocation in a female basketball player: a case report

Knee ligamentous injuries occur during sport, and when there is extensive injury, they can be associated with subluxation or dislocation. We present the case of a female basketball player who sustained a knee dislocation during noncontact play. An immediate angiogram confirmed vascular integrity, and surgical treatment with ligamentous reconstruction was performed. Peroneal nerve injury was present but resolved in 42 weeks. A review of the literature discussing knee dislocation is presented.