Changes in Anterior Segment Parameters After Laser Peripheral Iridotomy in Caucasian Eyes With Different Primary Angle Closure Mechanisms.

PRCIS: Subgrouping of angle closure mechanisms based on the swept-source optical coherence tomography images may help to identify the predominant underlying anatomic mechanism, evaluate personal treatment, and improve the better outcomes. PURPOSE: The purpose of this study was to evaluate changes in anterior segment parameters in Caucasian eyes with different angle closure mechanisms before and after laser peripheral iridotomy (LPI). METHODS: Sixty-six subjects underwent swept-source optical coherence tomography (CASIA, Tomey Corporation) angle imaging in the dark before and 7 days after LPI. On the basis of the baseline swept-source optical coherence tomography images, the eyes were categorized into 4 angle closure mechanisms, namely pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris (TPI), and large lens vault (LLV). Sixteen out of 128 cross-sectional images (11.25 degrees apart) per volume scan were selected for analysis. We used a generalized estimating equation to compare quantitative parameters among angle closure mechanisms and between before and after LPI after adjusting the intereye correlation. RESULTS: The mean age of subjects was 67.7±9.2 years, with the majority being female (82.2%). One hundred twenty-nine eyes (67 primary angle closure suspects, 34 primary angle closure, and 28 primary angle closure glaucoma) were categorized into PB (n=71, 55%), PIC (n=40, 31%), TPI (n=14, 10.9%), and LLV (n=4, 3.1%). Anterior chamber depth was the shallowest in the LLV, followed by TPI, PB, and PIC group at baseline. Widening of the angle and reduction of the iris curvature (IC) due to LPI were observed in all groups (all P <0.01). When compared to the PB group, the LPI-induced angle widening in the TPI group was significantly less even though the iris curvature reduction in the TPI group was greater (all P <0.05). CONCLUSIONS: In patients with angle closure, anterior segment morphology and LPI-induced angle widening were different among the various angle closure mechanisms.

Circumferential Assessment of Changes in Anterior Segment Characteristics and Baseline Predictors of Angle Widening After Laser Iridotomy in Caucasian Eyes.

PRCIS: Laser peripheral iridotomy (LPI) widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes and baseline refractive error, lens vault, and iris volume play a significant role in the angle widening. PURPOSE: The purpose of this study was to investigate circumferential angle widening and iris changes after LPI using swept-source optical coherence tomography (SS-OCT) in Caucasian eyes with the use of novel anterior segment parameters. MATERIALS AND METHODS: A total of 130 eyes (68 primary angle-closure suspect, 34 primary angle closure, and 28 primary angle-closure glaucoma eyes) of 66 subjects underwent 360-degree SS-OCT (SS-1000 CASIA) angle imaging and gonioscopy in the dark before and 7, 30, 90 days after LPI. For each eye, 16 frames (11.25 degree apart) were selected for analysis from 128 cross-sectional images, and novel 2-dimensional and 3-dimensional anterior segment parameters namely angle opening distance area (AODA) and the trabecular-iris space volume (TISV) 750 µm from the scleral spur, as well as iris parameters such as iris thickness (IT750 and IT2000), iris curvature, and iris curvature area were measured for each image. RESULTS: AODA and TISV were significantly increased and the iris curvature and iris curvature area were significantly decreased at days 7, 30, and 90 after LPI when compared with their baseline (all P<0.001) but there was no significant change in the IT750 and IT2000 (all P>0.05). The multivariable linear regression model showed a significant association of ΔAODA with refractive error (ß=-0.23, P=0.013), lens vault (ß=2.8, P=0.007), and iris volume (ß=-0.11, P=0.027) after adjusting for age and sex. CONCLUSIONS: LPI widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes in this study. Baseline refractive error, lens vault, and iris volume play a significant role in the circumferential angle widening by LPI.

Effect of stopping risedronate after long-term treatment on bone turnover.

CONTEXT: Determining how quickly bisphosphonate treatment effects begin to regress is crucial when considering termination of treatment. OBJECTIVE: Our objective was to assess the effects of 1 yr discontinuation of risedronate use in postmenopausal women with osteoporosis who had previously received risedronate for 2 or 7 yr. DESIGN AND SETTING: Before initiation of the current study, placebo/5-mg-risedronate patients had received placebo for 5 yr and risedronate for 2 yr, whereas 5-mg-risedronate patients had received risedronate for a total of 7 yr. Risedronate was then discontinued for 1 yr (yr 8). PATIENTS: Postmenopausal women with osteoporosis who had previously completed the 3-yr Vertebral Efficacy with Risedronate Therapy MultiNational (VERT-MN) pivotal trial, plus a 2-yr extension comparing risedronate or placebo for a total of 5 yr, followed by 2 yr of open-label risedronate treatment were enrolled in these trial extensions. MAIN OUTCOME MEASURES: Evaluations included changes in type I collagen cross-linked N-telopeptide (NTX)/creatinine (Cr) and bone mineral density (BMD) values, fracture incidence, and adverse events. RESULTS: After 1 yr of risedronate discontinuation, NTX/Cr levels increased toward baseline in both patient groups vs. the values at the end of yr 7. In both treatment groups, off-treatment total hip and femoral trochanter BMD values decreased, whereas lumbar spine and femoral neck BMD were maintained or slightly increased. The adverse event profiles were similar between the two treatment groups during yr 8. CONCLUSIONS: One year of discontinuation of risedronate treatment in patients who had received 2 or 7 yr of risedronate therapy led to increases in NTX/Cr levels toward baseline and decreases in femoral trochanter and total hip BMD.

Generation and identification of thymic epithelial progenitor cells pTEC by in-vitro processing of human thymic fragments for allotransplantation.

The procedure of generation and identification of stromal progenitor cells derived from human thymic fragments (PL patent 378431) has been described in this article. Our aim was to prepare material for transplantation in elderly people. The method is based on in-vitro processing of thymic fragments to get rid of all immunogenic elements of lymphocytes, endothelial cells, macrophages, and fibroblasts. In the thymic culture process, this organ dies out in the incubation medium and epithelial cells emerge out of the organ. After about 4 weeks from the start of the culture, the population of various developmental forms of epithelial cells was generated, namely CK AE1/AE3+, SDF-1 alpha+ and a weak expression of FGF+ S-100+. Finally, we obtained approximately 3 million cells as a monolayer. The progenitor cells were experimentally transplanted into a 72-year-old volunteer in order to prove that they do not induce neither a local nor a systemic rejection response.

Allotransplantation of cultured parathyroid progenitor cells without immunosuppression: clinical results.

BACKGROUND: Hypoparathyroidism is a well-known consequence of extensive thyroid and parathyroid surgery. Allotransplantation of cultured parathyroid cells can be considered as an alternative to vitamin D3 and calcium supplementation in treatment of hypoparathyroidism. We present the long-term allotransplant activity in 85 patients who had undergone cellular allotransplantation for surgical hypoparathyroidism. Also, a modified technique to prepare parathyroid explants is described for obtaining a new nonimmunogenic cell population. METHODS: From March 1990 to December 2004, 85 patients underwent 116 allotransplantations of cultured parathyroid cells. Mean recipient age was 46.2+/-11.1 years. Donors were selected from patients undergoing parathyroidectomy for secondary and tertiary hyperparathyroidism. RESULTS: After 6 weeks of cultivation and freezing, the parathyroid cells decreased their normal human leukocyte antigen (HLA) class I ABC expression and were free of HLA class II positive cells. The viability of cultured cells was 95.15+/-2.94%. Eighty-five patients underwent primary allotransplantation. Of these, 25 patients subsequently underwent a repeat procedure. In six cases, the parathyroid cells were obtained from the same donor and in 19 cases from a different donor. For all patients, the mean cellular allograft survival was 6.35+/-13.08 months. In 64 patients (55.1%), the allografts retained their endocrine function for more than 2 months. CONCLUSIONS: The present study has shown that in some patients parathyroid cell allotransplantation may be considered a method of treatment for permanent hypoparathyroidism after thyroid surgery. Graft function and/or survival did not depend on the baseline viability or secretory activity of cultured cells used for transplantation.

Vertebral fracture risk reduction with strontium ranelate in women with postmenopausal osteoporosis is independent of baseline risk factors.

UNLABELLED: Strontium ranelate (2 g/day) was studied in 5082 postmenopausal women. A reduction in incident vertebral fracture risk by 40% was shown after 3 years. This effect was independent of age, initial BMD, and prevalent vertebral fractures. INTRODUCTION: Strontium ranelate is an orally active treatment able to decrease the risk of vertebral and hip fractures in osteoporotic postmenopausal women. The aim of this study was to assess the efficacy of strontium ranelate according to the main determinants of vertebral fracture risk: age, baseline BMD, prevalent fractures, family history of osteoporosis, baseline BMI, and addiction to smoking. MATERIALS AND METHODS: We pooled data of two large multinational randomized double-blind studies with a population of 5082 (2536 receiving strontium ranelate 2 g/day and 2546 receiving a placebo), 74 years of age on average, and a 3-year follow-up. An intention-to-treat principle was used, as well as a Cox model for comparison and relative risks. RESULTS: The treatment decreased the risk of both vertebral (relative risk [RR] = 0.60 [0.53-0.69] p < 0.001) and nonvertebral (RR = 0.85 [0.74-0.99] p = 0.03) fractures. The decrease in risk of vertebral fractures was 37% (p = 0.003) in women <70 years, 42% (p < 0.001) for those 70-80 years of age, and 32% (p = 0.013) for those > or = 80 years. The RR of vertebral fracture was 0.28 (0.07-0.99) in osteopenic and 0.61 (0.53-0.70) in osteoporotic women, and baseline BMD was not a determinant of efficacy. The incidence of vertebral fractures in the placebo group increased with the number of prevalent vertebral fractures, but this was not a determinant of the effect of strontium ranelate. In 2605 patients, the risk of experiencing a first vertebral fracture was reduced by 48% (p < 0.001). The risk of experiencing a second vertebral fracture was reduced by 45% (p < 0.001; 1100 patients). Moreover, the risk of experiencing more than two vertebral fractures was reduced by 33% (p < 0.001; 1365 patients). Family history of osteoporosis, baseline BMI, and addiction to smoking were not determinants of efficacy. CONCLUSIONS: This study shows that a 3-year treatment with strontium ranelate leads to antivertebral fracture efficacy in postmenopausal women independently of baseline osteoporotic risk factors.

Bone metabolism and peritoneal membrane transport in children on chronic peritoneal dialysis.

OBJECTIVE: The aim of the study was to assess the influence of peritoneal membrane permeability on bone metabolism in dialyzed children. PATIENTS AND METHODS: 24 children with end-stage renal failure and being treated with peritoneal dialysis (PD) were studied. The children were divided into two groups based on the results of a standard peritoneal equilibration test: group I, high peritoneal transport [ratio of dialysate glucose concentration at 4 hours to dialysate glucose concentration at 0 hours (D/D0) < 0.26, dialysate-to-serum ratio of creatinine concentration at 4 hours (D/P) > 0.81], 10 children aged 9.9 +/- 2.9 years; group II, other peritoneal transport types (D/D0 > 0.26, D/P < 0.81), 14 children aged 11.4 +/- 2.7 years. Serum levels of calcium (sCa), phosphorus (sP), protein, albumin, alkaline phosphatase (AP), and parathormone (PTH) were measured, and bone biopsies were performed in all children. Alfacalcidol and calcium carbonate doses were adjusted to sCa, sP, and PTH levels in all patients. RESULTS: No statistically significant differences (NS) between the two groups were found in age, duration of PD, sCa, sP, AP, PTH, protein, or albumin levels. The mean alfacalcidol dose was 0.055 +/- 0.057 microg/kg body weight/ week in group I and 0.099 +/- 0.065 microg/kg/week in group II (p = NS). In group I, the high peritoneal transport group, significantly lower osteoclast surface (OcS/BS) and bone formation rate (BFR/TV) were found compared with group 11 (3.1% +/- 1.7% vs 4.6% +/- 2.0%, and 483.5 +/- 329.2 microm3/mm2/day vs 913.9 +/- 558.3 microm3/mm2/day, respectively, p < 0.05). We also found significant positive correlation between D/D0 and BFR/TV and OcS/BS (r = 0.45, p < 0.05). CONCLUSION: Bone turnover in children treated with PD may depend on peritoneal permeability.