Longitudinal Bone Loss Occurs at the Radius in CKD.

Chronic kidney disease (CKD) exposes to an increased incidence of fragility fractures. International guidelines recommend performing bone mineral density (BMD) if the results will impact treatment decisions. It remains unknown where bone loss occurs and what would preclude the longitudinal loss in patients with CKD. Here, we aimed to investigate factors influencing BMD and to analyze the longitudinal BMD changes. In the NephroTest cohort, we measured BMD at the femoral neck, total hip, lumbar spine, and proximal radius, together with circulating biomarkers and standardized measured glomerular filtration rate (mGFR) by <sup>51</sup> Cr-EDTA in a subset of patients with CKD stage 1 to 5 followed during 4.3 ± 2.0 years. A linear mixed model explored the longitudinal bone loss and the relationship of associated factors with BMD changes. A total of 858 patients (mean age 58.9 ± 15.2 years) had at least 1 and 477 had at least 2 BMD measures. At baseline, cross-sectional analysis showed a significantly lower BMD at femoral neck and total hip and a significant higher serum parathyroid hormone (PTH) along with CKD stages. Baseline age, gender, tobacco, low body mass index (BMI), and high PTH levels were significantly associated with low BMD. Longitudinal analysis during the mean 4.3 years revealed a significant bone loss at the radius only. BMD changes at the femoral neck were associated with BMI, but not CKD stages or basal PTH levels. CKD is associated with low BMD and high PTH in the cross-sectional analysis. Longitudinal bone loss occurred at the proximal radius after 4.3 years

Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism

Background Parathyroidectomy (PTX), either subtotal or total with forearm autografting, is a well-established treatment for refractory renal hyperparathyroidism (RHPT). However, 20–30% of patients develop persistent or recurrent disease. Obtaining accurate localization before reoperation is difficult. Patients and methods The study group comprised 21 consecutive adult patients (18 undergoing haemodialysis and 3 with a renal graft) imaged using 99mTc-sestamibi/123I subtraction scintigraphy. Of the 21 patients, 12 had undergone one previous PTX and the other 9 between two and four parathyroid operations. All patients had symptoms and signs of severe RHPT. The mean serum PTH level was 1,142 pg/ml. 99mTc-Sestamibi and 123I images were recorded simultaneously. Imaging views comprised a planar view of the neck and mediastinum, followed by a magnified pinhole view over the thyroid bed area. If parathyroid ectopy was detected, SPECT or SPECT-CT was performed. The forearm was imaged in case of autograft. Results Parathyroid scintigraphy was negative in one patient and positive in the other 20 (sensitivity 95.2%). One patient had uptake corresponding to two unresected parathyroid glands. Recurrence at the site of the partially resected gland or autograft was seen in 11 patients. However, six of them had a second 99mTc-sestamibi focus corresponding to a supernumerary parathyroid gland. Seven other patients had a supernumerary parathyroid gland as the sole cause of relapse. Three of the supernumerary glands showed major ectopy (intrathyroidal, low mediastinal, undescended within the vagus nerve). One patient had parathyromatosis with multiple parathyroid nodules scattered over the left side of the neck. Reoperation was possible in 13 patients, with no false-positive findings. Conclusion Many patients referred with the hypothesis of hyperplasia of a subtotally resected parathyroid gland or autograft were found to harbour a supernumerary parathyroid gland missed at the initial surgery

Numerical evidence for `multi-scalar stars'

We present a class of general relativistic soliton-like solutions composed of multiple minimally coupled, massive, real scalar fields which interact only through the gravitational field. We describe a two-parameter family of solutions we call ``phase-shifted boson stars'' (parameterized by central density rho_0 and phase delta), which are obtained by solving the ordinary differential equations associated with boson stars and then altering the phase between the real and imaginary parts of the field. These solutions are similar to boson stars as well as the oscillating soliton stars found by Seidel and Suen [E. Seidel and W.M. Suen, Phys. Rev. Lett. 66, 1659 (1991)]; in particular, long-time numerical evolutions suggest that phase-shifted boson stars are stable. Our results indicate that scalar soliton-like solutions are perhaps more generic than has been previously thought.Comment: Revtex. 4 pages with 4 figures. Submitted to Phys. Rev.

Evidence in chronic kidney disease–mineral and bone disorder guidelines: is it time to treat or time to wait?

Chronic kidney disease\u2013mineral and bone disorder (CKD\u2013MBD) is one of the many important complications associated with CKD and may at least partially explain the extremely high morbidity and mortality among CKD patients. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline document was based on the best information available at that time and was designed not only to provide information but also to assist in decision-making. In addition to the international KDIGO Work Group, which included worldwide experts, an independent Evidence Review Team was assembled to ensure rigorous review and grading of the existing evidence. Based on the evidence from new clinical trials, an updated Clinical Practice Guideline was published in 2017. In this review, we focus on the conceptual and practical evolution of clinical guidelines (from eMinence-based medicine to eVidence-based medicine and \u2018living\u2019 guidelines), highlight some of the current important CKD\u2013MBD-related changes, and underline the poor or extremely poor level of evidence present in those guidelines (as well as in other areas of nephrology). Finally, we emphasize the importance of individualization of treatments and shared decision-making (based on important ethical considerations and the \u2018best available evidence\u2019), which may prove useful in the face of the uncertainty over the decision whether \u2018to treat\u2019 or \u2018to wait\u2019

Supermassive black holes in scalar field galaxy halos

Ultra-light scalar fields provide an interesting alternative to WIMPS as halo dark matter. In this paper we consider the effect of embedding a supermassive black hole within such a halo, and estimate the absorption probability and the accretion rate of dark matter onto the black hole. We show that the accretion rate would be small over the lifetime of a typical halo, and hence that supermassive central black holes can coexist with scalar field halos.Comment: 5 pages RevTex4, no figures. Updated file to match published versio

Scalar Field Dark Matter

This work is a review of the last results of research on the Scalar Field Dark Matter model of the Universe at cosmological and at galactic level. We present the complete solution to the scalar field cosmological scenario in which the dark matter is modeled by a scalar field $\Phi$ with the scalar potential $V(\Phi)=V_{0}(cosh {(\lambda \sqrt{\kappa_{0}}\Phi)}-1)$ and the dark energy is modeled by a scalar field $\Psi$, endowed with the scalar potential $\tilde{V}(\Psi)= \tilde{V_{0}}(\sinh{(\alpha \sqrt{\kappa_{0}}\Psi)})^{\beta}$, which together compose the 95% of the total matter energy in the Universe. The model presents successfully deals with the up to date cosmological observations, and is a good candidate to treat the dark matter problem at the galactic level.Comment: 11 pagez, 5 figures, REVTeX. To appear in proceedings of the ``Mexican Meeting on Exact Solutions and Scalar Fields in Gravity '', in honour of Heinz Dehnen's 65th Birthday and Dietrich Kramer's 60th Birthday. Mexico D.F., Mexico, in press. More info at http://www.fis.cinvestav.mx/~siddh/PHI

Kneeling ability after total knee replacement

Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel. Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients. Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR. Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation. There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improtzve patient care and allow patients to return to this important activity

Boson-fermion stars: exploring different configurations

We use the flexibility of the concept of a fermion-boson star to explore different configurations, ranging from objects of atomic size and masses of the order $10^{18}$ g, up to objects of galactic masses and gigantic halos around a smaller core, with possible interesting applications to astrophysics and cosmology, particularly in the context of dark matter.Comment: 8 pages. Minor changes, new reference added and a few typos correcte

Dynamical Boson Stars

The idea of stable, localized bundles of energy has strong appeal as a model for particles. In the 1950s John Wheeler envisioned such bundles as smooth configurations of electromagnetic energy that he called {\em geons}, but none were found. Instead, particle-like solutions were found in the late 1960s with the addition of a scalar field, and these were given the name {\em boson stars}. Since then, boson stars find use in a wide variety of models as sources of dark matter, as black hole mimickers, in simple models of binary systems, and as a tool in finding black holes in higher dimensions with only a single killing vector. We discuss important varieties of boson stars, their dynamic properties, and some of their uses, concentrating on recent efforts.Comment: 79 pages, 25 figures, invited review for Living Reviews in Relativity; major revision in 201

Cosmological Dynamics of Phantom Field

We study the general features of the dynamics of the phantom field in the cosmological context. In the case of inverse coshyperbolic potential, we demonstrate that the phantom field can successfully drive the observed current accelerated expansion of the universe with the equation of state parameter $w_{\phi} < -1$. The de-Sitter universe turns out to be the late time attractor of the model. The main features of the dynamics are independent of the initial conditions and the parameters of the model. The model fits the supernova data very well, allowing for $-2.4 < w_{\phi} < -1$ at 95 % confidence level.Comment: Typos corrected. Some clarifications and references added. To appear in Physical Review