Sequential treatment with teriparatide and strontium ranelate in a postmenopausal woman with atypical femoral fractures after long-term bisphosphonate administration

AbstrAct ObJEctIVE: Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (bP) treatment has been established. DEsIGN: We report the outcome of teriparatide (trP) administration followed by strontium ranelate (sr) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with bP treatment. the spontaneous complete AFF was managed with intramedullary nailing, discontinuation of bP and initiation trP. rEsULts: Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the trP treatment, she had only slight discomfort in the femur with the incomplete AFF. bMD testing revealed increase of 7.61% at the lumbar spine (Ls) and 0.8% at the hip. Following trP, 1-year sr treatment resulted in further bMD increase of 9.2% at the Ls and 1.4% in the hip, while she does not report any pain. bone markers remain within the normal range. cONcLUsION: Our case indicates that sequential therapy with trP and sr in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of trP and sr, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF

Neogene non-tropical carbonate sedimentation in a warm temperate biogeographic province (Rethymnon Formation, Eastern Crete, Greece)

The Apostoli Basin, in the central-west part of Crete, was formed as a fore-arc type basin related to the convergent plate boundary between the African and the Eurasian plates. Most of the Neogene sediments filling the basin were deposited in a terrestrial to shallow marine environment. The succession is a transgressive cycle, which culminates in the alternation of Rethymnon bioclastic limestones with marls, documenting the important Tortonian marine transgression. The Rethymnon limestones are classified as a typical non-tropical carbonate lithofacies. Two particular lithofacies have been recognized: (a) a rhodalgal-type lithofacies, characterized by predominance of encrusting coralline algae and bryozoans, and (b) an echinofor-type lithofacies, characterized by predominance of echinoderms and/or benthic foraminifera. The coralline algae occur mostly as in situ spheroidal or branched rhodoliths, whereas benthic foraminifera are mainly represented by larger foraminifera. In both lithofacies, typical tropical carbonate elements are lacking. Skeletal elements consisted of low- and high-Mg calcite. Although the observed lithofacies possess many similarities with facies of non-tropical carbonates, the presence of large benthic foraminifera suggests development in a warm temperate biogeographic province. The depositional environment corresponds to a shallow ramp, the sediments being deposited in a nearshore environment and under conditions analogous to those prevailing in the present-day circalittoral bottoms of the Mediterranean Sea. The main carbonate accumulation area is located at the factory area itself (rhodalgal-type sediments), and downslope from the factory area (echinofor-type sediments). In the classic zonation of Mediterranean benthic assemblages of Peres and Picard [Rec. Trav. Stn. Mar. (1964)], the rhodalgal-type sediments of the Rethymnon Fm correspond to the "Facies a Pralines", developed in areas strongly controlled by currents (e.g., tops of plateaus), and the echinofor-type sediments to the "Detritique Cotier" bioclastic deposits, derived mostly by bioerosion and fragmentation of local and adjacent calcareous benthic communities. © 2002 Published by Elsevier Science B.V

Obstruction of the inferior vena cava with renal vein thrombosis

A case of obstruction of the inferior vena cava combined with renal vein thrombosis is reported in a 3 year old boy. The possible causes of inferior vena caval obstruction are listed and a brief review of the literature is presented. The significance of venocavography for the correct diagnosis of the syndrome is emphasized. Finally, the value of an early surgical procedure is discussed. © 1971, Sage Publications. All rights reserved

A preliminary investigation of Eocene larger benthic foraminifera assemblages from Alpine and molasse-type deposits of the Hellenic peninsula (Greece)

Larger Benthic Foraminifera (LBF) from five localities in Greece were studied in order to define the morphological features of various nummulitid forms and to describe the foraminiferal assemblages in different geotectonic environments. The selected sites belong to molasse-type formations in Kirki/Thrace Basin and Vasiliki Trikala/Mesohellenic Trough, and carbonate deposits in Alpine Pindos, Ionian and Tripolis geotectonic units. Taxonomic studies combined with biometric data, when possible, enabled us to identify different morphotypes. In the molasse-type deposits of Thrace Basin (Kirki Thrace), N. perforatus was found along with N. maximus and Assilina exponens suggesting correlation with biozone SBZ 16/17, while in the Mesohellenic Trough deposits (Vasiliki Trikala) the association included N. perforatus group, Operculina gomezi group and Silvestriella tetraedra, indicating a Bartonian age, SBZ 17-18A. In outcrops found within Pindos unit (Perivoli Grevena) three different assemblages have been observed in the microbreccious olistholiths, suggesting three distinguished deposits forming quasi-continuous succession spanning from early to middle and up to late Eocene. The Ionian unit (Manoliasa Ioannina) presented a mixed redeposited fauna including late Eocene, early Paleogene and planktonic foraminifera clasts. Finally, the Tripolis unit (Dervenakia and Tripolis) association was interpreted as Bartonian in age, defined by the presence of Operculina gomezi group and N. perforatus group. © 2020 Elsevier Masson SA

An Essential Role for Insulin and IGF1 Receptors in Regulating Sertoli Cell Proliferation, Testis Size, and FSH Action in Mice.

Testis size and sperm production are directly correlated to the total number of adult Sertoli cells (SCs). Although the establishment of an adequate number of SCs is crucial for future male fertility, the identification and characterization of the factors regulating SC survival, proliferation, and maturation remain incomplete. To investigate whether the IGF system is required for germ cell (GC) and SC development and function, we inactivated the insulin receptor (Insr), the IGF1 receptor (Igf1r), or both receptors specifically in the GC lineage or in SCs. Whereas ablation of insulin/IGF signaling appears dispensable for GCs and spermatogenesis, adult testes of mice lacking both Insr and Igf1r in SCs (SC-Insr;Igf1r) displayed a 75% reduction in testis size and daily sperm production as a result of a reduced proliferation rate of immature SCs during the late fetal and early neonatal testicular period. In addition, in vivo analyses revealed that FSH requires the insulin/IGF signaling pathway to mediate its proliferative effects on immature SCs. Collectively, these results emphasize the essential role played by growth factors of the insulin family in regulating the final number of SCs, testis size, and daily sperm output. They also indicate that the insulin/IGF signaling pathway is required for FSH-mediated SC proliferation

Normal flow-mediated vasodilatation of the brachial artery and carotid artery intima-media thickness in subclinical hypothyroidism

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 ± 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 ± 2.7 µIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 ± 8.5 years and mean TSH levels: 1.4 ± 0.6 µIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 ± 0.2 and 0.62 ± 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 ± 0.24 and 0.58 ± 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function