Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: A longitudinal study

Elevated bone mineral parameters have been associated with mortality in dialysis patients. There are conflicting data about calcium, parathyroid hormone (PTH), and mortality and few data about changes in bone mineral parameters over time. We conducted a prospective cohort study of 1007 incident hemodialysis and peritoneal dialysis patients. We examined longitudinal changes in bone mineral parameters and whether their associations with mortality were independent of time on dialysis, inflammation, and comorbidity. Serum calcium, phosphate, and calcium–phosphate product (CaP) increased in these patients between baseline and 6 months (P<0.001) and then remained stable. Serum PTH decreased over the first year (P<0.001). In Cox proportional hazards models adjusting for inflammation, comorbidity, and other confounders, the highest quartile of phosphate was associated with a hazard ratio (HR) of 1.57 (1.07–2.30) using both baseline and time-dependent values. The highest quartiles of calcium, CaP, and PTH were associated with mortality in time-dependent models but not in those using baseline values. The lowest quartile of PTH was associated with an HR of 0.65 (0.44–0.98) in the time-dependent model with 6-month lag analysis. We conclude that high levels of phosphate both at baseline and over follow-up are associated with mortality in incident dialysis patients. High levels of calcium, CaP, and PTH are associated with mortality immediately preceding an event. Promising new interventions need to be rigorously tested in clinical trials for their ability to achieve normalization of bone mineral parameters and reduce deaths of dialysis patients

Mapping the cortical representation of the lumbar paravertebral muscles

Objective: The aim of this study was to map the cortical representation of the lumbar spine paravertebral (LP) muscles in healthy subjects. Methods: Transcranial magnetic stimulation (TMS) was employed to map the cortical representations of the LP muscles at two sites. Stimuli were applied to points on a grid representing scalp positions. The amplitude of motor evoked potentials (n = 6) was averaged for each position. Results: The optimal site for evoking responses in the contralateral LP muscles was situated 1 cm anterior and 4 cm lateral to the vertex. Ipsilateral responses were evoked from sites lateral to the optimal site for evoking contralateral responses. Contralateral responses were also obtained from areas anterior to the optimal site. Conclusions: Maps of these muscles can be produced. The results suggest discrete contra- and ipsilateral cortical projections. Anterior sites at which excitation can be evoked may indicate projections arising in the SMA are involved. Significance: This study provides normative data regarding the cortical representation of the paravertebral muscles and provides a technique for evaluating cortical motor plasticity in patients presenting with spinal pathologies

Magnetic Properties of YBa_2Cu_3O_{7-\delta} in a self-consistent approach: Comparison with Quantum-Monte-Carlo Simulations and Experiments

We analyze single-particle electronic and two-particle magnetic properties of the Hubbard model in the underdoped and optimally-doped regime of \YBCO by means of a modified version of the fluctuation-exchange approximation, which only includes particle-hole fluctuations. Comparison of our results with Quantum-Monte Carlo (QMC) calculations at relatively high temperatures ($T\sim 1000 K$) suggests to introduce a temperature renormalization in order to improve the agreement between the two methods at intermediate and large values of the interaction $U$. We evaluate the temperature dependence of the spin-lattice relaxation time $T_1$ and of the spin-echo decay time $T_{2G}$ and compare it with the results of NMR measurements on an underdoped and an optimally doped \YBCO sample. For $U/t=4.5$ it is possible to consistently adjust the parameters of the Hubbard model in order to have a good {\it semi-quantitative} description of this temperature dependence for temperatures larger than the spin gap as obtained from NMR measurements. We also discuss the case $U/t\sim 8$, which is more appropriate to describe magnetic and single-particle properties close to half-filling. However, for this larger value of $U/t$ the agreement with QMC as well as with experiments at finite doping is less satisfactory.Comment: Final version, to appear in Phys. Rev. B (sched. Feb. 99

Quantitative comparison of single- and two-particle properties in the cuprates

We explore the strong variations of the electronic properties of copper-oxygen compounds across the doping phase diagram in a quantitative way. To this end we calculate the electronic Raman response on the basis of results from angle-resolved photoemission spectroscopy (ARPES). In the limits of our approximations we find agreement on the overdoped side and pronounced discrepancies at lower doping. In contrast to the successful approach for the transport properties at low energies, the Raman and the ARPES data cannot be reconciled by adding angle-dependent momentum scattering. We discuss possible routes towards an explanation of the suppression of spectral weight close to the $(\pi,0)$ points which sets in abruptly close to 21% doping.Comment: 7 pages, 4 figure