The role of hormonal therapy in osteoporosis

W społeczeństwach rozwiniętych na okres po menopauzie przypada 1/3 długości życia kobiety. Występujący w tym czasie deficyt estrogenów istotnie wpływa na przebieg wielu procesów metabolicznych przyczyniając się do rozwoju chorób, a w konsekwencji pogorszenia jakości życia. Do tkanek estrogenozależnych należą między innymi kości. Brak ochronnego wpływu estrogenów prowadzi do przesunięcia dynamicznej równowagi przemian kostnych w kierunku resorpcji, przez co zmniejszeniu ulega masa kostna, pogorsza się jej jakość i zwiększa ryzyko niskoenergetycznych złamań. W ostatnich latach poglądy na temat stosowania estrogenowo-gestagennej terapii hormonalnej stały się bardzo kontrowersyjne. Wyniki licznych badań klinicznych nie są jednoznaczne, a argumenty zarówno za, jak i przeciw często podyktowane emocjami. Potwierdzono, że terapia hormonalna zapobiega pogarszaniu jakości kości oraz wpływa ochronnie na kość zmniejszając ryzyko złamań osteoporotycznych. Racjonalna analiza korzyści w stosunku do ryzyka oraz wnikliwa ocena stanu zdrowia pacjentek umożliwia optymalny wybór terapii. Indywidualizacja w doborze leków zmniejszających ryzyko złamań pozwala na skorzystanie z dostępnych dobrodziejstw terapii hormonalnej z równoczesnym zachowaniem jej bezpieczeństwa. (Endokrynol Pol 2011; 62 (1): 61-64)In developed societies, the post-menopausal period covers approximately one third of a woman’s life. The deficit of oestrogens observed during the post-menopausal period significantly affects the course of many metabolic processes, causing a number of diseases and in consequence diminishing quality of life. Among others, bones belong to oestrogen-dependent tissues. The deficit of the protective influence of oestrogens compromises the dynamic balance of the bone transformation process towards resorption, thus reducing bone mass and quality, while increasing the risk of low-energy fractures. In recent years, differing views on the application of oestrogen/gestagen therapy have reached the level of controversy. The results of numerous clinical studies are far from unequivocal, with the whole subject one of heated debate. It has been confirmed that hormonal therapy prevents bone quality deterioration, while opening a protective umbrella around the bone, reducing the risk of osteoporotic fractures. A rational approach to weighing possible advantages against possible risks and a thorough evaluation of a patient’s health condition allows for optimal therapy selection. (Pol J Endocrinol 2011; 62 (1): 61-64

Suspended sediment routing through a small on-stream reservoir based on particle properties

Purpose A novel concept of suspended sediment (SS) routing through a small reservoir is proposed that relies on the particle properties in the reservoir inflow. Methods The SS routing through the reservoir is described following the single continuous stirred tank reactor concept with only one model parameter, the SS decay coefficient. This parameter is linked to the sediment settling velocity and water flow velocity. Hence, the model does not require a direct calibration with recorded data. This model was tested on a small reservoir in Warsaw, Poland, with seven storm events. Suspended sediment samples at the reservoir inflow and outflow were taken manually during the passage of flood flows at irregular intervals. The performance of the proposed method was verified with the approach when the model parameter is estimated directly from recorded events. Results The parameter calculated based on particle properties was about 10 times higher than the corresponding parameter optimized from recorded SS events. Hence, there was a need to introduce a correction factor to accurately predict the effluent SS. This led to a high model performance for all events (Nash-Sutcliffe = 0.672 on average). Conclusions (i) The proposed SS routing model based on particle properties has been proven to accurately simulate SS in the reservoir outlet. (ii) Thus, the parameter can be estimated from the sediment settling velocity and water flow velocity, but the correction factor must be applied. (iii) Our findings acknowledge difficulties in describing SS routing through small reservoirs and indicate a lack of knowledge on the functioning of these reservoirs

Fever, pain and swelling in the calf — possible symptoms of acquired hemophilia

W pracy przedstawiono skomplikowany przypadek pacjentki z chorobami nowotworowymi w wywiadzie, po przebytej chemio- i radioterapii, żywionej parenteralnie z powodu popromiennego zwężenia jelit. Po kilku miesiącach stwierdzono u niej nabytą hemofilię. Pomimo zastosowania leków omijających inhibitor krwawień nie udało się wyeliminować. Zastosowano immunotolerancję: krwawienia się zmniejszyły, ale do eradykacji inhibitora nie doszło. W związku z niepowodzeniem dotychczasowych schematów leczenia włączono rytuksymab, dzięki czemu uzyskano znaczne zmniejszenie miana inhibitora, a krwawienia ustąpiły. Chora przez 2 miesiące nie zgłaszała się na badania kontrolne. Na oddział ratunkowy w miejscu zamieszkania trafiła z masywnym krwawieniem z przewodu pokarmowego oraz objawami wstrząsu hipowolemicznego. Wkrótce doszło do nagłego zatrzymania krążenia. Podjęta akcja reanimacyjna okazała się nieskuteczna.The paper presents a complex case of a cancer patient with a history of chemotherapy and radiotherapy, parenteral nutrition due to radiation-induced bowel obstruction and acquired hemophilia diagnosed after several months. As result of immune tolerance induction (ITI) the bleeding decreased but no inhibitor eradication was achieved. In view of the failure of pre- vious treatment regimens rituximab was administered and resulted in significant reduction of inhibitor titer and the bleeding cessation. The patient did not report for follow-up tests for two months. She was admitted to the emergency ward of her regional hospital with massive gastrointestinal bleeding and symptoms of hypovolemic shock, followed by sudden cardiac arrest. Resuscitation was unsuccessful

Dependence of flood peaks and volumes in modeled discharge time series: effect of different uncertainty sources

Flood estimates needed for designing efficient and cost-effective flood protection structures are usually derived using observed peak discharges. This approach neglects, firstly, that floods are characterized not only by peak discharge but also by flood volume, and, secondly, that these characteristics are subject to modifications under climate and land use changes. Bivariate flood frequency analysis based on simulated discharge time series makes it possible to consider both flood peak and flood volume in design flood estimation. Further, this approach considers changes in discharge characteristics by using discharge series generated from climate time series used as an input for a hydrological model. Such series are usually not available at an hourly resolution but at a certain aggregation level (e.g. 24 h) and might not perfectly represent observed precipitation distributions. In this study, we therefore investigate how the aggregation and distribution of precipitation series and discharge distribution affect flood peaks and volumes and their dependence. We propose a framework for assessing the uncertainty in bivariate design flood estimates that is caused by different factors in the modeling chain, which consists of precipitation-discharge modeling, flood event sampling, and bivariate flood frequency analysis. The uncertainty sources addressed are precipitation aggregation and distribution, parameter and model uncertainty, and discharge resolution. Our results show that all of these uncertainty sources are relevant for design flood estimation and that the importance of the individual uncertainty sources is catchment dependent. Our results also demonstrate that substantial uncertainty is introduced already in the first step of the model chain because commonly used calibration procedures do not take into account the reproduction of flood volumes. Researchers should be aware of such deficiencies when performing bivariate flood frequency analysis on modeled discharge time series and should aim to tailor model calibration procedures to the problem at hand

Downsizing parameter ensembles for simulations of rare floods

For extreme-flood estimation, simulation-based approaches represent an interesting alternative to purely statistical approaches, particularly if hydrograph shapes are required. Such simulation-based methods are adapted within continuous simulation frameworks that rely on statistical analyses of continuous streamflow time series derived from a hydrological model fed with long precipitation time series. These frameworks are, however, affected by high computational demands, particularly if floods with return periods > 1000 years are of interest or if modelling uncertainty due to different sources (meteorological input or hydrological model) is to be quantified. Here, we propose three methods for reducing the computational requirements for the hydrological simulations for extreme-flood estimation so that long streamflow time series can be analysed at a reduced computational cost. These methods rely on simulation of annual maxima and on analysing their simulated range to downsize the hydrological parameter ensemble to a small number suitable for continuous simulation frameworks. The methods are tested in a Swiss catchment with 10 000 years of synthetic streamflow data simulated thanks to a weather generator. Our results demonstrate the reliability of the proposed downsizing methods for robust simulations of rare floods with uncertainty. The methods are readily transferable to other situations where ensemble simulations are needed

Hyperstability of the Fréchet Equation and a Characterization of Inner Product Spaces

We prove some stability and hyperstability results for the well-known Fr´echet equation stemming fromone of the characterizations of the inner product spaces. As the main tool, we use a fixed point theorem for the function spaces.We finish the paper with some new inequalities characterizing the inner product spaces

Foreign body in the tongue as a result of accidental gunshot from hunting rifle

Gunshots are one of the many causes of urgent admission of patients due to necessity of removing foreign bodies and bleeding control. A 63 y.o. patient was referred to the Department of Oral Surgery due to an accidental gunshot, which occurred in early adolescence and caused numerous post-gunshot injuries. The decision to waive surgical removal of foreign body was dictated by major risk of complications, such as: major bleeding from tongue vessels and probability of function loss. Also the lack of symptoms sustained such decision. Patient was informed about the necessity of performing the surgery in case of any pain, inflammation or necessity of proper interpretation of radiological examination (CT, MRI)

On Stability of a General Bilinear Functional Equation

We prove the Hyers–Ulam stability of the functional equation f(a1x1 + a2x2, b1y1 + b2y2) = C1f(x1, y1) (∗) + C2f(x1, y2) + C3f(x2, y1) + C4f(x2, y2) in the class of functions from a real or complex linear space into a Banach space over the same field. We also study, using the fixed point method, the generalized stability of (∗) in the same class of functions. Our results generalize some known outcomes

On a general bilinear functional equation

Let X, Y be linear spaces over a field K. Assume that f : X-2 -> Y satisfies the general linear equation with respect to the first and with respect to the second variables, that is, {f(a(1)x(1) + a(2)x(2), y) = A(1)f(x(1), y) + A(2)f(x(2), y) f(x, b(1)y(1) + b(2)y(2)) = B(1)f(x, y(1)) + B(2)f(x, y(2)), (*) for all x, x(i), y, y(i) is an element of X and with a(i), b(i) is an element of K\{0}, A(i), B-i is an element of K (i is an element of {1, 2}). It is easy to see that such a function satisfies the functional equation f(a(1)x(1) + a(2)x(2), b(1)y(1) + b(2)y(2)) = C(1)f(x(1), y(1)) + C(2)f(x(1), y(2)) + C(3)f(x(2), y(1)) + C(4)f(x(2), y(2)), (**) for all x(i), y(i) is an element of X (i is an element of {1, 2}), where C-1 := A(1)B(1), C-2 := A(1)B(2), C-3 := A(2)B(1), C-4 := A(2)B(2). We describe the form of solutions and study relations between (*) and (**)

Variability of the initial abstraction ratio in an urban and an agroforested catchment

The Curve Number method is one of the most commonly applied methods to describe the relationship between the direct runoff and storm rainfall depth. Due to its popularity and simplicity, it has been studied extensively. Less attention has been given to the dimensionless initial abstraction ratio, which is crucial for an accurate direct runoff estimation with the Curve Number. This ratio is most often assumed to be equal to 0.20, which was originally proposed by the method’s developers. In this work, storm events recorded in the years 2009–2017 in two small Polish catchments of different land use types (urban and agroforested) were analyzed for variability in the initial abstraction ratio across events, seasons, and land use type. Our results showed that: (i) estimated initial abstraction ratios varied between storm events and seasons, and were most often lower than the original value of 0.20; (ii) for large events, the initial abstraction ratio in the catchment approaches a constant value after the rainfall depth exceeds a certain threshold value. Thus, when using the Soil Conservation Service-Curve Number (SCS-CN) method, the initial abstraction ratio should be locally verified, and the conditions for the application of the suggested value of 0.20 should be established