Femoral bone mineral density at the time of hip fracture is higher in women with versus without type 2 diabetes mellitus: a cross-sectional study.

PURPOSE: To compare femoral bone mineral density (BMD) levels in hip-fracture women with versus without type 2 diabetes mellitus (T2DM). We hypothesized that BMD levels could be higher in the women with T2DM than in controls and we aimed to quantify the BMD discrepancy associated with the presence of T2DM. METHODS: At a median of 20 days after the occurrence of an original hip fracture due to fragility we measured BMD by dual-energy x-ray absorptiometry at the non-fractured femur. RESULTS: We studied 751 women with subacute hip fracture. Femoral BMD was significantly higher in the 111 women with T2DM than in the 640 without diabetes: mean T-score between-group difference was 0.50, (95% CI from 0.30 to 0.69, P < 0.001). The association between the presence of T2DM and femoral BMD persisted after adjustment for age, body mass index, hip-fracture type, neurologic diseases, parathyroid hormone, 25-hydroxyvitamin D and estimated glomerular filtration rate (P < 0.001). For a woman without versus with T2DM, the adjusted odds ratio to have a femoral BMD T-score below the threshold of - 2.5 was 2.13 (95% CI from 1.33 to 3.42, P = 0.002). CONCLUSIONS: Fragility fractures of the hip occurred in women with T2DM at a femoral BMD level higher than in control women. In the clinical assessment of fracture risk, we support the adjustment based on the 0.5 BMD T-score difference between women with and without T2DM, although further data from robust longitudinal studies is needed to validate the BMD-based adjustment of fracture risk estimation.

Can the size of the contact area body-ground influence the presence of acute pulmonary emphysema in cases of incomplete hanging?

In a recently published study, we showed that acute pulmonary emphysema (APE) was present in cases of death by incomplete hanging and absent in cases of complete hanging. This result suggested a possible role of the hanging position on the respiratory distress of these victims. To further investigate this hypothesis, in the present study, we compared cases of incomplete hanging with a small contact area between body and ground (group A) to cases of incomplete hanging with a large contact area (group B). As positive and negative control group, we investigated cases of freshwater drowning (group C) and acute external bleeding (group D) respectively. Pulmonary samples were histologically examined, and the mean alveolar area (MAA) for each group was measured by digital morphometric analysis. MAA was 23,485 µm2 for group A and 31,426 µm2 for group B (p < 0.05). MAA of group B was similar to MAA of positive control group (33,135 µm2) and MAA of group A was similar to MAA of negative control group (21,991 µm2). These results seem to confirm our hypothesis and suggest that the size of the contact area between body and ground influences the presence of APE. Furthermore, the present study showed that APE can be proposed as a vitality sign in incomplete hanging, but only in cases with a large contact area between body and ground.

Fat embolism after intraosseous catheters in pediatric forensic autopsies.

In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

Electron-phonon coupling and vibrational properties of size-selected linear carbon chains by resonance Raman scattering.

UV resonance Raman spectroscopy of size-selected linear sp-carbon chains unveils vibrational overtones and combinations up to the fifth order. Thanks to the tunability of the synchrotron source, we excited each H-terminated polyyne (HCnH with n = 8,10,12) to the maxima of its vibronic absorption spectrum allowing us to precisely determine the electronic and vibrational structure of the ground and excited states for the main observed vibrational mode. Selected transitions are shown to enhance specific overtone orders in the Raman spectrum in a specific way that can be explained by a simple analytical model based on Albrecht's theory of resonance Raman scattering. The determined Huang-Rhys factors indicate a strong and size-dependent electron-phonon coupling increasing with the sp-carbon chain length.

Vibrational properties of graphdiynes as 2D carbon materials beyond graphene.

Two-dimensional (2D) hybrid sp-sp2 carbon systems are an appealing subject for science and technology. For these materials, topology and structure significantly affect electronic and vibrational properties. We investigate here by periodic density-functional theory (DFT) calculations the Raman and IR spectra of 2D carbon crystals belonging to the family of graphdiynes (GDYs) and having different structures and topologies. By joining DFT calculations with symmetry analysis, we assign the IR and Raman modes in the spectra of all the investigated systems. On this basis, we discuss how the modulation of the Raman and IR active bands depends on the different interactions between sp and sp2 domains. The symmetry-based classification allows identifying the marker bands sensitive to the different peculiar topologies. These results show the effectiveness of vibrational spectroscopy for the characterization of new nanostructures, deepening the knowledge of the subtle interactions that take place in these 2D materials.

Creation of a Forensic Pathology Biobank in Switzerland: which issues and research opportunities?

A biobank is a collection of biological material associated with health database. The field of biobanking has significantly developed over the past 30 years. Research based on biobank material gives access to data of a large number of people and can often significantly accelerate the understanding of disease and improve the quality of care. In the University Center of Legal Medicine Lausanne-Geneva, samples collected during autopsies are used for forensic investigations. The legal and ethical framework to use these samples for research is often complex and confused, which is unfortunate given the potential of these biospecimens. Indeed, forensic samples are valuable for research because they originate in part from young (including pediatrics cases) and healthy people who are poorly represented in worldwide institutional biobanks. In this context at the beginning of the year 2019, the Forensic Pathology Biobank was created. Creation of a forensic pathology biobank is the best way to standardize local conservation practices and improve personal data management, thus providing a very valuable biological material for scientific projects. Its development gives rise to many questions about technical standards, ethical and legal issues but also many research opportunities.

Non-invasive characterisation of molecular diffusion of agent into turbid matrix using micro-SORS.

This study proposes a non-invasive analytical method to study the molecular diffusion of a chemical agent into a turbid matrix with an emerging analytical technique, micro-Spatially Offset Raman Spectroscopy (micro-SORS). Here, the micro-SORS concept has been extended from the analysis of chemically distinct stratified layers to the studies and monitoring of the absorption and diffusion processes, addressing a key analytical need in a number of areas including polymer, pharmaceutical, forensic and biomedical sciences. In Cultural Heritage the knowledge of the penetration depth of a polymer used to consolidate or to protect an object, or the absorption depth of solvents used during a cleaning procedure is crucial for the performance evaluation of restoration methods and their safety towards the work of art. To date the most common protocol for obtaining this type of information comprises the application of stratigraphical analysis on cross-sections prepared after taking a small amount of sample from the work of art. This approach is destructive and may lack of statistical meaning, since the analytical information is limited to the micro area of sampling. To overcome these drawbacks, in this study micro-SORS was successfully used, for the first time, to non-invasively characterise the penetration of a polymer and of a viscous solvent into a gypsum substrate, permitting the reconstruction of the diffusion trends of the products into the matrix and the evaluation of their performances.

Outside rules inside: the role of electron-active substituents in thiophene-based heterophenoquinones.

The biradicaloid vs. quinoidal character of the ground state of thiophene-based heterophenoquinones bearing donor or acceptor groups is investigated. Keeping the conjugation length fixed, namely, the 5,5'-bis(3,5-di-tert-butyl-4-oxo-2,5-cyclohexadiene-1-ylidene)-2,2'-dihydroxy bithiophene backbone, an opposite effect occurs depending on the donating or withdrawing nature of the substituents. The character of the ground state depends not only on the electronic nature of the substituents but also on their position on the molecular skeleton: donor groups on the 3,3'-positions of the bithiophene central core stabilize a quinoidal ground state, whereas a biradicaloid electronic structure results from the introduction of the same donor groups onto the lateral phenones. Withdrawing groups behave similar to donors, but in the opposite direction.

A single postdischarge telephone call by an occupational therapist does not reduce the risk of falling in women after hip fracture: a randomized controlled trial.

BACKGROUND: Post-discharge telephone calls to reinforce targeted recommendations for fall prevention have scarcely been investigated in hip-fracture survivors. AIM: To assess the effectiveness of a single telephone call by an occupational therapist in reducing the proportion of fallers (primary endpoint) and improving the adherence to targeted recommendations for fall prevention (secondary endpoint) after hospital discharge in hip-fracture women. DESIGN: Randomized controlled trial. SETTING: Post-acute rehabilitation hospital and community (post-discharge). POPULATION: We randomized 169 of 228 women with a fall-related fracture of the hip. Data for analyses were available for 153 women (78 from the intervention group and 75 controls). METHODS: All the women underwent a multidisciplinary program targeted at fall prevention during post-acute inpatient rehabilitation. Additionally, the intervention group received a telephone call by an occupational therapist to reinforce the targeted recommendations for fall prevention at a median of 18 days after discharge. The outcomes were assessed at a six-month follow-up. RESULTS: Eleven of the 78 women (14.1%) from the intervention group, and 10 of the 75 (13.3%) from the controls sustained at least one fall during the follow-up (relative risk=1.06; 95% CI from 0.48 to 2.34). The mean adherence to the recommendations for fall prevention was 75.1% in the intervention group and 71.2% in the controls (between group difference 3.9; 95% CI from -3.4 to 11.3; P=0.29). CONCLUSION: Our study does not support a post-discharge telephone call to reinforce the recommendations for fall prevention in hip-fracture women. CLINICAL REHABILITATION IMPACT: We contribute to elucidate one aspect of multidisciplinary fall-prevention strategies in hip-fracture survivors.

Which type of exercise therapy is effective after hip arthroplasty? A systematic review of randomized controlled trials.

BACKGROUND: Early multidisciplinary rehabilitation can improve the recovery after total hip arthroplasty (THA). However, optimal exercise therapy has not been defined. We aimed to answer the question: "Which type and/or timing of exercise therapy is effective following THA?" DESIGN: Systematic review. METHODS: We searched four databases: MEDLINE, PEDro, Cochrane Library, and Cinahl since January 2008 till December 2012. Literature before 2008 was not searched for, because it was previously analyzed by two systematic reviews. Eligible criteria for studies were: Randomized Controlled Trials (RCTs); English language; interventions on type and/or timing of physical exercise initiating after THA; outcome measures including at least one among impairment, activity, participation, quality of life, or length of stay in hospital. RESULTS: Eleven papers on nine RCTs were identified. Trial quality was mixed. PEDro scores ranged from four to eight. Exercise therapy varied greatly in type and timing. Each of the nine RCTs addressed a specific issue and overall the results were sparse. In the early postoperative phase favorable outcomes were due to ergometer cycling and maximal strength training. Inconclusive results were reported for aquatic exercises, bed exercises without external resistance or without its progressive increase according to the overload principle, and timing. In the late postoperative phase (> 8 weeks postoperatively) advantages were due to weight-bearing exercises. CONCLUSION: Insufficient evidence exists to build up a detailed evidence-based exercise protocol after THA. Sparse results from few RCTs support specific exercise types which should be added to the usual mobility training in THA patients.

Parathyroid hormone response to severe vitamin D deficiency is sex associated: an observational study of 571 hip fracture inpatients.

OBJECTIVES: To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: 571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min. MEASUREMENTS: In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml). RESULTS: Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023). CONCLUSIONS: Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.

Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture: post-hoc analyses of a quasi-randomized controlled trial.

BACKGROUND: Few studies focused on fall prevention in hip-fracture survivors. AIM: To investigate the role of adherence to targeted recommendations on both home environment and behaviors in affecting the hazard of falling after a fall-related hip fracture. DESIGN: Post-hoc analysis of a quasi-randomized controlled trial. SETTING: Post-acute rehabilitation hospital. POPULATION: Ninety-five of 119 women living in the community with a fall-related fracture of the hip. METHODS: We assessed home hazard of falling and suggested targeted modifications of home environment and behaviors in activities of daily living to prevent falls during inpatient rehabilitation. Falls were recorded at a six-month follow-up during a pre-planned home visit. RESULTS: Nineteen of the 95 women sustained at least one fall during the six-month follow-up. Women with > 2 uncorrected risk factors had a significantly higher risk of falling than those with 0-2 risk factors; the odds ratio adjusted for four confounders was 4.58 (95%CI 1.472-4.250; P=0.009). Adherence to recommendations for fall prevention was negatively associated with fall risk. The adjusted odds ratio for a ten percent increase in adherence rate was 0.749 (95%CI 0.594-0.945; P=0.015). CONCLUSION: Uncorrected environmental and behavioral risk factors and poor adherence to targeted recommendations for fall prevention significantly predicted the risk of falling in community-dwelling women who sustained a fall-related hip fracture. CLINICAL REHABILITATION IMPACT: Fall-risk assessment should be performed during inpatient rehabilitation following a fall-related hip fracture. Improving adherence to targeted recommendations emerges as a major goal to prevent falls in hip-fracture survivors.

Raman scattering of molecular graphenes.

A simplified theoretical approach for modeling the off-resonance Raman scattering of molecular models of confined graphene (polycyclic aromatic hydrocarbons, PAHs) is presented and compared with the results from density functional theory calculations. This theoretical analysis not only allows for a quick estimate of the Raman scattering activity, but also correlates the Raman response to simple quantities directly linked to the molecular electronic structure. Owing to its simplicity and computational convenience the model can be applied to extended graphitic systems. The results of the Hückel calculations of the off-resonance Raman bond polarizability parameters of nanometer sized armchair and zizgag graphene flakes are shown.

A single amino acid substitution in highly similar endo-PGs from Fusarium verticillioides and related Fusarium species affects PGIP inhibition.

Endo-polygalacturonase (PG) may be a critical virulence factor secreted by several fungi upon plant invasion. The single-copy gene encoding PG in Fusarium verticillioides and in eight other species of the Gibberella fujikuroi complex (F. sacchari, F. fujikuroi, F. proliferatum, F. subglutinans, F. thapsinum, F. nygamai, F. circinatum, and F. anthophilum) was functionally analyzed in this paper. Both the nucleotide and amino acid sequences were highly similar among the 12 strains of F. verticillioides analyzed, as well as among those from the G. fujikuroi complex. The PGs were not inhibited by the polygalacturonase-inhibiting proteins (PGIPs) from the monocot asparagus and leek plants, but were inhibited to variable extents by bean PGIP. PGs from F. verticillioides, F. nygamai and one strain of F. proliferatum were barely inhibited. Residue 97 within PG was demonstrated to contribute to the different levels of inhibition. Together these findings provide new insights into the structural and functional relationships between the PG from the species of the G. fujikuroi complex and the plant PGIP.

Role in anxiety behavior of the endocannabinoid system in the prefrontal cortex.

In the present study we explored with a multidisciplinary approach, the role of anandamide (AEA) in the modulation of anxiety behavior at the level of the prefrontal cortex (PFC). Low doses of the metabolically stable AEA analog, methanandamide, microinjected into the PFC, produced an anxiolytic-like response in rats, whereas higher doses induced anxiety-like behaviors. Pretreatment with the selective antagonist of CB1 or TRPV1 receptors (AM251 and capsazepine, respectively) suggested that the anxiolytic effect evoked by AEA might be due to the interaction with the CB1 cannabinoid receptor, whereas vanilloid receptors seem to be involved in AEA anxiogenic action. When AEA contents in the PFC were increased by microinjecting the selective inhibitor of fatty acid amide hydrolase (FAAH), URB597, we observed an anxiolytic response only at low doses of the compound and no effect or even an anxiogenic profile at higher doses. In line with this, a marked decrease of AEA levels in the PFC, achieved by lentivirus-mediated local overexpression of FAAH, produced an anxiogenic response. These findings support an anxiolytic role for physiological increases in AEA in the PFC, whereas more marked increases or decreases of this endocannabinoid might lead to an anxiogenic response due to TRPV1 stimulation or the lack of CB1 activation, respectively.

Relation between risk factors and cardiovascular complications in patients with peripheral vascular disease. Results from the A.D.E.P. study.

The relationship between risk factors and the onset of cardiovascular events was analyzed in patients suffering from peripheral obstructive arterial disease. One thousand and eleven patients were recruited in 120 Italian centers and participated in a clinical trial on picotamide (A.D.E.P. study), whose results have been previously reported. Patients were followed-up for 18 months and cardiovascular events were recorded. Hypertension (35%), smoking (34%), and diabetes (19%) were the most common risk factors at baseline. During the follow-up period, 246 patients (11.7%) had a cardiovascular event, mainly affecting cerebral, cardiac or peripheral circulation. Thirty-five of these events (14.2%) were fatal. A logistic regression analysis showed in general that hypertension (odds ratio 1.48), an ankle arm pressure ratio lower than 0.8 (odds ratio 1.42), smoking (odds ratio 1.43), previous vascular surgery (odds ratio 1.35), high white blood cell (WBC) count (odds ratio 1.15 for a difference of 2.0 x 10(9) WBC/1) and plasma fibrinogen (odds ratio 1.16 for a difference of 1.05 g/l) were significantly associated with a higher incidence of cardiovascular events. In particular, deaths of any origin were more frequent in patients with an ankle/arm pressure ratio below 0.8. High plasma fibrinogen increased the risk of cerebrovascular events, hypertension or coronary heart events and, to a less evident extent, peripheral vascular complications and cerebrovascular events. A history of vascular surgery increased the risk of peripheral vascular complications. Both smoking and a high WBC count showed to be borderline significant risk factors for coronary heart events and the former also for peripheral vascular complications. In male patients (84%), ankle/arm pressure ratio lower than 0.8, high fibrinogen and hypertension were the most important factors for cardiovascular events. This study helps to identify some categories at higher risk of cardiovascular events among patients with peripheral obstructive arterial disease; this finding is useful to plan future trials to decrease the frequency of such complications.

Effect of salmon calcitonin on deoxypyridinoline (Dpyr) urinary excretion in healthy volunteers.

To evaluate the influence of synthetic salmon calcitonin (SMC) on bone resorption we investigated the modifications in urinary cross-links excretion [pyridinoline (Pyr) and deoxypyridinoline (Dpyr)] induced by a single dose of the drug. The study was carried out in 16 healthy volunteers given a single dose of either 50 IU SMC I.M. or placebo, according to a double-blind, cross-over design. Urine was collected every 24 hours during the 72 hours after each treatment and Pyr and Dpyr were measured by an automated HPLC method. Pyr showed no significant difference after the two treatments, whereas in the first 24-hour urine collection Dpyr (nmol/24 hours +/- SD) was considerably lower after SMC than after placebo (118.9 +/- 26.0 against 147.2 +/- 45.0, P < 0.05). The amount of saved Dpyr was 19.2%. The selective effect of SMC on Dpyr excretion was more evident comparing the Pyr/Dpyr ratios for placebo and SMC during the first day of the study (4.1 +/- 0.6 against 4.8 +/- 0.7, respectively, P < 0.01). Using Eyre's formula (10 nmol Dpyr = 0.17 g bone) and assuming that no Dpyr is metabolized, the mean daily amount of bone resorbed was calculated (2.5 g for placebo and 2.0 g for SMC). The difference is the index of the bone-saving effect of SMC (0.48 g/day, or 19.2%). In conclusion, assuming that in healthy volunteers bone turnover is balanced with equal rates of formation and resorption, a dose of 50 IU I.M. of SMC reduces resorption, with a bone gain in the first 24 hours calculated as 9.4 mg/IU.