Incidence and progression of ankle osteoarthritis: The johnston county osteoarthritis project.

OBJECTIVE: To determine the incidence and progression of ankle osteoarthritis (OA) and associated risk factors in a community-based cohort of African Americans and whites. METHODS: Data were from 541 participants who had standardized lateral and mortise radiography of the ankles in weight bearing at baseline (2013-2015) and follow-up (2017-2018). Incident radiographic ankle OA (rAOA) was defined as a Kellgren-Lawrence grade (KLG) ≥ 1 at follow-up among ankles with baseline KLG < 1; progressive rAOA was a ≥ 1 KLG increase at follow-up among ankles with KLG ≥ 1 at baseline. Symptoms were assessed using self-reported pain, aching, and stiffness (PAS) on most days and the Foot and Ankle Outcome Score (FAOS) symptoms subscale. Ankle-level logistic regression models were used to assess associations of ankle outcomes with covariates (age, sex, race, body mass index [BMI], smoking, number of symptomatic joints, comorbidities, prior ankle injury, and knee or foot OA). RESULTS: Among ankles without rAOA at baseline, 28% developed incident rAOA, 37% had worsening FAOS symptoms, and 7% had worsening PAS. Incident rAOA and worsening ankle symptoms were associated with higher BMI and symptoms in other joints. Among ankles with baseline rAOA, 4% had progressive rAOA, 35% had worsening of FAOS symptoms, and 9% had worsening PAS. rAOA progression was associated with ankle injury and concomitant knee or foot OA; worsening of symptoms was associated with higher BMI and other symptomatic joints. CONCLUSIONS: Not all ankle OA is post-traumatic. Smoking prevention/cessation, a healthy weight, and injury prevention may be methods for reducing the incidence and progression of rAOA.

Temporal Trends and Factors Associated with Bisphosphonate Discontinuation and Restart.

Adverse events related to long-term use of bisphosphonates have raised interest in temporary drug discontinuation. Trends in bisphosphonate discontinuation and restart, as well factors associated with these decisions, are not fully understood at a population level. We investigated temporal trends of bisphosphonate discontinuation from 2010 to 2015 and identified factors associated with discontinuation and restart of osteoporosis therapy. Our cohort consisted of long-term bisphosphonate users identified from 2010 to 2015 Medicare data. We defined discontinuation as ≥12 months without bisphosphonate prescription claims. We used conditional logistic regression to compare factors associated with alendronate discontinuation or osteoporosis therapy restart in the 120-day period preceding discontinuation or restart referent to the 120-day preceding control periods. Among 73,800 long-term bisphosphonate users, 59,251 (80.3%) used alendronate, 6806 (9.2%) risedronate, and 7743 (10.5%) zoledronic acid, exclusively. Overall, 26,281 (35.6%) discontinued bisphosphonates for at least 12 months. Discontinuation of bisphosphonates increased from 1.7% in 2010, reaching a peak of 14% in 2012 with levels plateauing through 2015. The factors most strongly associated with discontinuation of alendronate were: benzodiazepine prescription (adjusted odds ratio [aOR] = 2.5; 95% confidence interval [CI] 2.1, 3.0), having a dual-energy X-ray absorptiometry (DXA) scan (aOR = 1.8; 95% CI 1.7, 2.0), and skilled nursing facility care utilization (aOR = 1.8; 95% CI 1.6, 2.1). The factors most strongly associated with restart of osteoporosis therapy were: having a DXA scan (aOR = 9.9; 95% CI 7.7, 12.6), sustaining a fragility fracture (aOR = 2.8; 95% CI 1.8, 4.5), and an osteoporosis or osteopenia diagnosis (aOR = 2.5; 95% CI 2.0, 3.1). Our national evaluation of bisphosphonate discontinuation showed that an increasing proportion of patients on long-term bisphosphonate therapy discontinue medications. The factors associated with discontinuation of alendronate were primarily related to worsening of overall health status, whereas traditional factors associated with worsening bone health were associated with restarting osteoporosis medication. © 2019 American Society for Bone and Mineral Research.

Trigeminal Neuralgia Secondary to Vertebrobasilar Dolichoectasia Treated with Cyberknife Stereotactic Radiosurgery.

Trigeminal neuralgia caused by vertebrobasilar dolichoectasia is a rare condition. It is characterized by paroxysmal hemifacial pain which is lancinating in type mostly refractory to medical management. This is a report of trigeminal neuralgia secondary to vertebral dolicholectasia refractory to medical management treated with cyber knife stereotactic radiosurgery to the dose of 66 Gy in single fraction to the proximal nerve root. Pain relief was achieved immediately after the treatment and with a follow up period of 2 years, patient is pain free. Cyberknife assisted radiosurgery is relatively safe in delivering high ablative doses with precise conformality to small target regions like proximal nerve root entry of trigeminal nerve with no major toxicities and achieving early pain relief. It is an outpatient and non-invasive procedure. It can be used as a definite treatment modality for trigeminal neuralgia induced by vertebrobasilar dolichoectasia.

Improving drug adherence in osteoporosis: an update on more recent studies.

Similar to other chronic diseases such as diabetes and hypertension, osteoporosis has struggled with suboptimal medication adherence, resulting in an increased risk of fractures and all-cause mortality. The goal of this narrative review was to summarize interventions to improve medication adherence in osteoporosis. Because past reviews of this topic covered published literature through 2013, we conducted our literature search to include the period between January 2012 and November 2017. We identified 10 studies evaluating healthcare system and patient interventions aimed at improving osteoporosis treatment adherence, including three fracture liaison service (FLS) programs, one pharmacist-delivered counseling program, and six patient-directed interventions consisting of three coaching or counseling programs and three interventions using reminder prompts. Four out of the six patient-directed interventions did not lead to significant improvements in outcomes, suggesting that patient-directed interventions may have limited success in this setting. The healthcare system interventions that evaluated FLS programs and pharmacist-directed tailored counseling were effective at improving medication adherence; however, the studies were not randomized, they were costly, resource intensive and effective in countries with more centralized healthcare, possibly limiting their generalizability. In conclusion, while healthcare system interventions such as FLS, and pharmacist-delivered counseling appeared to be successful in improving osteoporosis medication adherence in some settings, behavioral interventions including patient counseling and reminder prompts for medication utilization were not, perhaps due to patient perceptions regarding osteoporosis consequences and need for treatment. Thus, these patient attributes may define patients 'at high risk' for poor adherence and developing intervention approaches to enhance patient knowledge and understanding of osteoporosis and its consequences may improve the perception of the need for treatment, optimize osteoporosis care and thereby improve overall outcomes of patients with osteoporosis. We hope that the knowledge gained through our review will help inform the design of further programs aimed at optimizing osteoporosis care.

Synthesis, structural, and photoluminescence studies of Gd(terpy)(H2O)(NO3)2M(CN)2 (M = Au, Ag) complexes: multiple emissions from intra- and intermolecular excimers and exciplexes.

The highly luminescent bimetallic cyanide materials, Gd(terpy)(H(2)O)(NO(3))(2)M(CN)(2) (M = Au, Ag; GdAu and GdAg, respectively) are quick and easy to synthesize under ambient conditions. A characteristic feature exhibited by both solid-state compounds is an intense red emission when excited with UV light. Additionally, GdAu exhibits a broad-band green emission upon excitation in the near UV region. A combination of structural and spectroscopic results for the compounds helps explain the underlying conditions responsible for their unique properties. Single-crystal X-ray diffraction experiments expose their structural features, including the fact that they are isostructural. Crystallographic data for the representative GdAu compound (Mo K(α), λ = 0.71073 Å, T = 290 K): triclinic, space group P ̅1, a = 7.5707(3) Å, b = 10.0671(4) Å, c = 15.1260(4) Å, α = 74.923(3)°, ß = 78.151(3)°, γ = 88.401(3)°, V = 1089.04(7) Å(3), and Z = 2. Although the compounds crystallize as dimers containing M···M distances smaller than the sum of their van der Waals radii, the Au···Au (3.5054(4) Å) and/or the Ag···Ag (3.6553(5) Å) interactions are relatively weak and are not responsible for the low energy red emission. Rather, the green emission in GdAu presumably originates from the [Au(CN)(2)(-)](2) dimeric excimer, while the [Ag(CN)(2)(-)](2) dimers in GdAg do not display visible emission at either 290 or 77 K. The unusual red emission exhibited by both compounds likely originates from the formation of an excited state exciplex that involves intermolecular π-stacking of 2,2':6',2"-terpyridine ligands. The room-temperature and low-temperature steady-state photoluminescent properties, along with detailed time-dependent, lifetime, and quantum yield spectroscopic data provide evidence regarding the sources of the multiple visible emissions exhibited by these complexes.

Emission enhancement through dual donor sensitization: modulation of structural and spectroscopic properties in a series of europium tetracyanoplatinates.

The synthesis of three different europium tetracyanoplatinates all incorporating 2,2':6',2''-terpyridine (terpy) have been carried out in acetonitrile/water mixtures by reaction of Eu(3+) salts with terpy and potassium tetracyanoplatinate. The use of different Eu(3+) sources results in the isolation of Eu(C(15)H(11)N(3))(H(2)O)(2)(NO(3))(Pt(CN)(4)) x CH(3)CN (1), {Eu(C(15)H(11)N(3))(H(2)O)(3)}(2)(Pt(CN)(4))(3) x 2 H(2)O (2), or [Eu(C(15)H(11)N(3))(H(2)O)(2)(CH(3)COO)(2)](2)Pt(CN)(4) x 3 H(2)O (3) for the nitrate, triflate, or acetate salts, respectively. All three compounds have been prepared as colorless crystals, and single-crystal X-ray diffraction has been used to investigate their structural features. Crystallographic data (MoK alpha, lambda = 0.71073 A, T = 290 K): 1, monoclinic, space group P2(1)/c, a = 12.835(1), b = 15.239(1), c = 13.751(2) A, beta = 105.594(9) degrees, V = 2590.8(5) A(3), Z = 4; 2, triclinic, space group P1, a = 9.1802(8) A, b = 10.8008(9) A, c = 13.5437(9) A, alpha = 84.491(6) degrees, beta = 75.063(7) degrees, gamma = 79.055(7) degrees, V = 1272.4(2) A(3), Z = 1; 3, triclinic, space group P1, a = 12.110(3) A, b = 12.7273(11) A, c = 18.7054(16) A, alpha = 92.859(7) degrees, beta = 92.200(11) degrees, gamma = 118.057(10) degrees, V = 2534.8(7) A(3), Z = 2. Variation of the counteranions in these systems provides the opportunity to modify the structures and coordination environment of Eu(3+) for 1-3. Compounds 1 and 2 are both one-dimensional, polymeric compounds that contain Eu(3+) ions chelated by terpy and bridged by tetracyanoplatinate anions. 3 is a zero-dimensional complex salt in which Eu(3+) is coordinated by terpy, acetate, and water, but not tetracyanoplatinate. The structural differences result in varying sensitization phenomena for the three compounds. Compounds 1 and 2 display efficient donor-acceptor intramolecular energy transfer (IET) where dual donor species, terpyridine and tetracyanoplatinate, simultaneously enhance the acceptor Eu(3+) emission. In both compounds the donor species are directly coordinated to the acceptor ion, and hence a highly efficient dual-donor effect is exhibited for the IET mechanisms. In 3 where only the terpy ligand is directly coordinated to Eu(3+), the sensitization involves only one donor species. The Pt(CN)(4)(2-) unit in 3, which lacks direct bonding to Eu(3+), exhibits strong emission indicating the lack of cooperative enhancement of the lanthanide emission.