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.     

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.     

A conjugate gradient-based algorithm to minimize the sidelobe levelof planar arrays with element failures

Element failures increase the sidelobe power level of an array. Reconfiguring the amplitude and phase distribution of the remaining elements can partially compensate for the failed elements and thus reduce the sidelobe level. An algorithm is obtained that yields the reconfigured distribution by minimizing the ratio of the average peak sidelobe power level to the power in the main beam, taking into account the defective elements. The minimization of this nonlinear function is carried out via a conjugate gradient method. The algorithm is applied to the synthesis of sum and difference patterns of planar arrays     

缺陷问题驱动浸没光刻技术发展

涂层的应用导致晶圆上缺陷的增加或者使光刻表现发生变化虽然现在推测浸没光刻技术的量产时间还太早,但是许多公司正在努力确定生产线何时能从干法工艺跃为湿法工艺。根据最近在San Jose举办的     

A physically based approach to granular media mechanics: grain-scale experiments,initial results and implications to numerical modeling

It is generally appreciated that the mechanical behavior of granular media depends fundamentally on the interaction of the constituent particles, and that the validity of numerical models of granular media would be greatly improved with knowledge of the grain-scale mechanics. However, most supporting experimental work has been conducted on highly idealized materials, and a limited amount of information exists on grain-scale force–displacement relationships for naturally occurring materials. To address this shortcoming, we are conducting a program that integrates laboratory experiments on grains of naturally occurring aggregate with the discrete element modeling method, with the goal of relating the grain-scale physical and mechanical properties of granular media to bulk behavior. The paper describes the equipment and methods that have been developed to conduct close-loop controlled, grain-scale experiments under monotonic and cyclic loading conditions, and presents results from an initial set of experiments on unbonded grains. The implications of the grain-scale results to the discrete element model are discussed. Discussions center on the applicability of a physically based approach to the mechanics of granular media in general. In light of future exploration missions and the resulting need to predict the mechanical properties of lunar and planetary regoliths, the paper examines the potential usefulness of our physically based approach to the problem of predicting the behavior of the types of materials found in those environments.     

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.