Treatment of high fracture risk patients in routine clinical practice.

A retrospective cohort study determined the high incidence of recurrent fractures in osteoporotic patients with high fracture risk during the observation. The strategy of starting treatment with more potent regimens (zoledronic acid, denosumab and/or teriparatide) seems to have the best secondary fracture prevention efficacy. OBJECTIVE: This paper describes the various medical therapy regimens prescribed to osteoporotic patients with high fracture risk and the result of treatment. METHODS: We carried out a retrospective cohort study in selected Osteoporosis Centers. Patients were considered to have high fracture risk in case of a history of a low-energy hip fracture or two or more vertebral or other site fractures. A total of 812 subjects (768 women and 44 men) aged 36-95 years were included. The observation period was 2285.1 patient-years. Demographic data, clinical findings, and BMD data obtained by DXA, as well as a history of fractures that had occurred during the follow-up, were included in the analysis. RESULTS: Overall, at baseline, there were 637 non-vertebral fractures including 104 hip fractures. A total of 590 patients had vertebral fractures; of these, 69% suffered multiple fractures. Being on treatment, 119 (14.7%) patients developed new vertebral and non-vertebral fractures. The incidence of new non-vertebral fractures and hip fractures was 39.4 and 13.1 per 1000 patient-years. The total number of vertebral fractures increased by 24.8% from 1353 to 1689. The best results of the treatment were achieved in patients who were started on zoledronic acid, denosumab, or teriparatide and had an adequate duration of treatment. Although these patients had significantly lower BMD values at the time of diagnosis compared with other patients, they showed a lower incidence of new vertebral and hip fractures, during the follow-up. CONCLUSION: Therapy of patients at high risk of fractures started with more potent treatment regimens (zoledronic acid, denosumab and/or teriparatide) of adequate duration was more effective in terms of prevention of new vertebral and hip fractures as compared with other treatment options. However, treatment appears to be challenging given the number of recurrent fractures in patients on treatment and the frequency of drug withdrawal or replacement.

Polariton-assisted splitting of broadband emission spectra of strongly coupled organic dye excitons in tunable optical microcavity.

Resonance interaction between a localized electromagnetic field and excited states in molecules paves the way to control fundamental properties of a matter. In this study, we encapsulated organic molecules with relatively low unoriented dipole moments in the polymer matrix, placed them in tunable optical microcavity and realized, for the first time, controllable modification of the broad photoluminescence (PL) emission of these molecules in strong coupling regime at room temperature. Notably, while in most previous studies it was reported that the single mode dominates in the PL signal (radiation of the so-called branch of the lower polariton), here we report on the observation of two distinct PL peaks, evolution of which has been followed as the microcavity mode is detuned from the excitonic resonance. A significant Rabi splitting estimated from the modified PL spectra was as large as 225 meV. The developed approach can be used both in fundamental research of resonant light-mater coupling and its practical applications in sensing and development of coherent spontaneous emission sources using a combination of carefully designed microcavity with a wide variety of organic molecules.

A gradient of radioactive contamination in Dolon village near the SNTS and comparison of computed dose values with instrumental estimates for the 29 August, 1949 nuclear test.

Spatial distributions of soil contamination by 137Cs (89 sampling points) and 239+240Pu (76 points) near and within Dolon village were analyzed. An essential exponential decrease of contamination was found in Dolon village: the distance of a half reduction in contamination is about 0.87-1.25 km (in a northwest-southeast direction from the supposed centerline of the radioactive trace). This fact is in agreement with the available exposure rate measurements near Dolon (September 1949 archive data): on the basis of a few measurements the pattern of the trace was estimated to comprise a narrow 2 km corridor of maximum exposure rate. To compare computed external doses in air with local dose estimates by retrospective luminescence dosimetry (RLD) the gradient of radioactive soil contamination within the village was accounted for. The computed dose associated with the central axis of the trace was found to be equal to 2260 mGy (calculations based on archive exposure rate data). Local doses near the RLD sampling points (southeast of the village) were calculated to be in the range 466-780 mGy (averaged value: 645+/-70 mGy), which is comparable with RLD data (averaged value 460+/-92 mGy with range 380-618 mGy). A comparison of the computed mean dose in the settlement with dose estimates by ESR tooth enamel dosimetry makes it possible to estimate the "upper level" of the "shielding and behavior" factor in dose reduction for inhabitants of Dolon village which was found to be 0.28+/-0.068.

International intercomparison of retrospective luminescence dosimetry method: sampling and distribution of the brick samples from Dolon' village, Kazakhstan.

There are still many differences in dose estimates depending on the applied methods of retrospective dosimetry in the areas, which were affected by nuclear tests at the Semipalatinsk nuclear test site (SNTS). In order to provide more correct estimation of radiation doses to population in proximity to the SNTS an International Intercomparison of Retrospective Luminescence Dosimetry (RLD) method had been proposed. It was suggested there be a comparison of the dose estimates for the brick samples from the buildings in the settlement, suffered following nuclear tests at the SNTS. With this purpose, during the September-October 2002 field mission, the team of specialists from Kazakhstan and Japan had collected four whole bricks for RLD International Intercomparison. Three buildings were selected as sampling locations in Dolon' village (Kazakhstan). The slices from these bricks were distributed between six laboratories in Finland, Germany, Japan, Russia, UK and USA for independent estimations by the RLD method of the accumulated dose of external irradiation. The descriptions of sampling, locations, data on geographical coordinates, dates of building construction, mode of cutting of samples for distribution, labeling, condition of transportation, order of the distribution of samples and information concerning 137Cs and 239+240Pu soil contamination density in the village and near sampling locations are presented in the paper.