Osteoporosis guidelines from a rehabilitation perspective: systematic analysis and quality appraisal using AGREE II

Background: People affected by osteoporosis and fragility fractures often report disability and poor health-related quality of life. Albeit rehabilitation has a crucial role in older people, post-menopausal women and other subjects with high risk of fragility fractures, the rehabilitation perspective has been poorly investigated in the available guidelines for osteoporosis. Aim: To systematically evaluate the quality of guidelines for osteoporosis from a rehabilitation perspective. Design: Systematic analysis of guidelines. Setting: Not applicable. Population: Osteoporotic patients. Methods: On May 2020, we performed a systematic search on medical literature of all guidelines published in the last 10 years on PubMed, PEDro, and international guideline databases. The study selection was based on key terms "exercise", "physical activity" or "rehabilitation". All authors independently assessed the methodological quality through the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument, consisting of six domains (scope, stakeholder involvement, rigor and development, clarity of presentation, applicability, editorial independence). Results: Out of 331 documents retrieved, a total of 34 guidelines were selected after the screening phases. Twenty (58.8%) high quality guidelines were reported. According to AGREE II instrument, a mean score of 78.1±21.8% was reported for "scope and purpose" domain; for stakeholder involvement, the mean score was 58.1±22.1%; the rigor of development was good (mean score of 61.3±27.3%); for clarity of presentation the mean score was 79.4±20.3%; the applicability was poor (mean score of 30.9±25.2%); for editorial independence the mean score was 75.1±24.6%. Rehabilitation recommendations for osteoporotic patients were reported in 21 (61.8%) of the selected guidelines. Conclusions: This is the first systematic analysis evaluating quality of the guidelines for osteoporosis using AGREE II instrument. Starting from a state of the art of the currently available evidence, we could conclude that therapeutic exercise at moderate to high intensity is encouraged by several guidelines for the management of people with osteoporosis and fragility fractures. More than half of guidelines were of high-quality. However, most guidelines are lacking specific indications about exercise features. Clinical rehabilitation impact: This study might support the implementation of a rehabilitation perspective in the guidelines for osteoporotic patients

Early Denosumab for the prevention of osteoporotic fractures in breast cancer women undergoing aromatase inhibitors: A case-control retrospective study

BACKGROUND:Aromatase inhibitors (AIs) might have a detrimental impact on bone health in breast cancer (BC) women.Denosumab has been shown to reduce the risk of fractures, but the appropriate time for starting is yet to be clearly defined.OBJECTIVE:To evaluate the effects of early treatment with Denosumab (612 months after starting AIs) compared to a delayedtreatment in BC women.METHODS:In this retrospective case-control study, we included medical records of BC post-menopausal women, treated withAIs therapy; they were divided as: study group (starting Denosumab612 months after AIs) and control group (>12 months). Atthe baseline (T0) and at 18 months (T1), we evaluated the lumbar spine (LS) Tscore and femoral neck (FN) Tscore. Furthermore,at T1 we assessed the incident fragility fractures.RESULTS:Fifty-nine BC survivors (mean age: 61.5±11.5 years) were included: 28 with Early Denosumab and 31 with LateDenosumab. At T1, the study group did not show any incident hip or vertebral fragility fracture, whereas the Late Denosumabgroup showed 2 incident hip fractures (6.5%) and 4 (12.9%) vertebral fragility fractures. Early Denosumab showed a significantpositive effect on both LS (p=0.044) and FN (p=0.024) Tscore variations.CONCLUSION:Taken together, our findings suggest that an early start of Denosumab might be considered for the osteoporosismanagement in BC women undergoing AIs

QCD Evolution Equations: Numerical Algorithms from the Laguerre Expansion

A complete numerical implementation, in both singlet and non-singlet sectors, of a very elegant method to solve the QCD Evolution equations, due to Furmanski and Petronzio, is presented. The algorithm is directly implemented in x-space by a Laguerre expansion of the parton distributions. All the leading-twist distributions are evolved: longitudinally polarized, transversely polarized and unpolarized, to NLO accuracy. The expansion is optimal at finite x, up to reasonably small x-values ($x\approx 10^{-3}$), below which the convergence of the expansion slows down. The polarized evolution is smoother, due to the less singular structure of the anomalous dimensions at small-x. In the region of fast convergence, which covers most of the usual perturbative applications, high numerical accuracy is achieved by expanding over a set of approximately 30 polynomials, with a very modest running time.Comment: 30 pages, 13 figure

The Kinetic Interpretation of the DGLAP Equation, its Kramers-Moyal Expansion and Positivity of Helicity Distributions

According to a rederivation - due to Collins and Qiu - the DGLAP equation can be reinterpreted (in leading order) in a probabilistic way. This form of the equation has been used indirectly to prove the bound $|\Delta f(x,Q)| < f(x,Q)$ between polarized and unpolarized distributions, or positivity of the helicity distributions, for any $Q$. We reanalize this issue by performing a detailed numerical study of the positivity bounds of the helicity distributions. To obtain the numerical solution we implement an x-space based algorithm for polarized and unpolarized distributions to next-to-leading order in $\alpha_s$, which we illustrate. We also elaborate on some of the formal properties of the Collins-Qiu form and comment on the underlying regularization, introduce a Kramers-Moyal expansion of the equation and briefly analize its Fokker-Planck approximation. These follow quite naturally once the master version is given. We illustrate this expansion both for the valence quark distribution $q_V$ and for the transverse spin distribution $h_1$.Comment: 38 pages, 27 figures, Dedicated to Prof. Pierre Ramond for his 60th birthda

Testing the Quasi-temporal Gauge on the Lattice

We investigate the viability of the quasi-temporal gauge on the lattice. This is a complete gauge fixing condition that can be implemented on the lattice at a very low computational cost. As a test case, using the Clover action, we have evaluated the (gauge invariant) renormalisation constant of the non-singlet axial current, using Ward identities extracted from quark states. Our result is in reasonable but not complete agreement with previous values obtained from Ward identities both on hadronic states and on quark states in the Landau gauge. We observe large fluctuations due to lattice Gribov copies. The influence of finite volume effects is expected to be non-negligible in the case we are considering.Comment: 10 pages, uuencoded Postscript file including 2 figure

Permeability pathways for non-electrolytes through Bufo bufo gall-bladder

Amphotericin B treatment increases the thiourea, D-xylose and mannitol fluxes and lowers those of urea, N-methyl-urea, acetamide, formamide, and N-N'-dimethyl-thiourea. The degree of flux inhibition is related to the cellular permeability of these compounds. Most probably Amphotericin B increases the permeability of all those molecules across the luminal plasma membrane, but simultaneously elicits a cellular swelling, which reduces the diffusion across the lateral plasma membranes. This effect masks the polyene effect especially for molecules showing a mainly cellular permeation pathway such as amides and lipid soluble molecules

Effect of cycloheximide on urea facilitated transport through toad gallbladder epithelium

Transepithelial urea outfluxes across toad gallbladder were determined before and after the addition of cycloheximide. The drug inhibits the movement of urea but has no effect on thiourea and antipyrine outfluxes. The inhibition of amide transport is time dependent as also shown in counterflow experiments. These results are consistent with the hypothesis that cycloheximide inhibits the synthesis of membrane proteic sites involved in urea mediated transport