Clinical utility of bone turnover markers in monitoring the withdrawal of treatment with oral bisphosphonates in postmenopausal osteoporosis

Summary Bone markers may be useful to monitor response to treatment withdrawal in osteoporosis. We used two criteria for investigating the change in BTMs after withdrawal of bisphosphonate treatment. A larger increase in BTMs was associated with greater bone loss. Bone markers may be useful in monitoring of patients taking a pause from treatment. Introduction Measurement of bone turnover markers (BTMs) may be useful to monitor offset of treatment with bisphosphonates (BP) in osteoporosis. We assessed the effect of withdrawal of BP treatment by comparing the changes in BTMs and total hip (TH) bone density (BMD). Methods We studied postmenopausal osteoporotic women who had completed a randomised study of three oral BPs. After 2 years of treatment, participants with BMD T-score > − 2.5 and in whom it was considered clinically appropriate to discontinue treatment, were invited to participate in a further 2-year observational study. Biochemical response was assessed using BTMs (CTX and PINP) with offset being defined by two criteria: (1) an increase greater than the least significant change (LSC) and (2) an increase above the reference mean value. Results Fifty women completed the study. At 48 weeks after stopping BPs, CTX was greater than the LSC for 66% of women and PINP 72%; CTX was above the reference mean for 64% of women and PINP 42%. The decrease in THBMD was greater for women with the largest increase in BTM compared to those with continued suppression (mean difference for CTX was − 2.98%, 95%CI − 4.75 to − 1.22, P < 0.001, PINP − 2.25%, 95% CI − 4.46 to − 0.032, P = 0.046). Conclusion The measurement of BTM after withdrawal of BPs is potentially useful to evaluate patients that are taking a pause from treatment. An increase in BTMs more than the LSC and/or reference mean reflects loss of treatment effect and identifies patients that are likely to have a decrease in BMD. Such changes could provide an indication for reintroduction of treatment

Chemical telemetry of OH observed to measure interstellar magnetic fields

We present models for the chemistry in gas moving towards the ionization front of an HII region. When it is far from the ionization front, the gas is highly depleted of elements more massive than helium. However, as it approaches the ionization front, ices are destroyed and species formed on the grain surfaces are injected into the gas phase. Photodissociation removes gas phase molecular species as the gas flows towards the ionization front. We identify models for which the OH column densities are comparable to those measured in observations undertaken to study the magnetic fields in star forming regions and give results for the column densities of other species that should be abundant if the observed OH arises through a combination of the liberation of H2O from surfaces and photodissociation. They include CH3OH, H2CO, and H2S. Observations of these other species may help establish the nature of the OH spatial distribution in the clouds, which is important for the interpretation of the magnetic field results.Comment: 11 pages, 2 figures, accepted by Astrophysics and Space Scienc

Optimal mixing of buoyant jets and plumes in stratified fluids: Theory and experiments

The influence of ambient fluid stratification on buoyant miscible jets and plumes is studied theoretically and experimentally. Given a fixed set of jet/plume parameters, and an ambient fluid stratification sandwiched between top and bottom homogeneous densities, a theoretical criterion is identified to show how step-like density profiles constitute the most effective mixers within a broad class of stable density transitions. This is assessed both analytically and experimentally, respectively by establishing rigorous a priori estimates on generalized Morton-Taylor-Turner (MTT) models (Morton et al., Proc. R. Soc. Lond. A, vol. 234, 1956, pp. 1-23; Fischer et al., Mixing in Inland and Coastal Waters. Academic, 1979), and by studying a critical phenomenon determined by the distance between the jet/plume release height with respect to the depth of the ambient density transition. For fluid released sufficiently close to the background density transition, the buoyant jet fluid escapes and rises indefinitely. For fluid released at locations lower than a critical depth, the buoyant fluid stops rising and is trapped indefinitely. A mathematical formulation providing rigorous estimates on MTT models is developed along with nonlinear jump conditions and an exact critical-depth formula that is in good quantitative agreement with the experiments. Our mathematical analysis provides rigorous justification for the critical trapping/escaping criteria, first presented in Caulfield & Woods (J. Fluid Mech., vol. 360, 1998, pp. 229-248), within a class of algebraic density decay rates. Further, the step-like background stratification is shown to be the most efficient mixing profile amongst a broad family of stably stratified profiles sharing the same density transition within a fixed distance. Finally, the analysis uncovers surprising differences between the Gaussian and top-hat profile closures concerning initial mixing of the jet and ambient fluid

Effect of selenium supplementation on musculoskeletal health in older women : a randomised, double-blind, placebo-controlled trial

Background Observational and preclinical studies show associations between selenium status, bone health, and physical function. Most adults in Europe have serum selenium below the optimum range. We hypothesised that selenium supplementation could reduce pro-resorptive actions of reactive oxygen species on osteoclasts and improve physical function. Methods We completed a 6-month randomised, double-blind, placebo-controlled trial. We recruited postmenopausal women older than 55 years with osteopenia or osteoporosis at the Northern General Hospital, Sheffield, UK. Participants were randomly assigned 1:1:1 to receive selenite 200 μg, 50 μg, or placebo orally once per day. Medication was supplied to the site blinded and numbered by a block randomisation sequence with a block size of 18, and participants were allocated medication in numerical order. All participants and study team were masked to treatment allocation. The primary endpoint was urine N-terminal cross-linking telopeptide of type I collagen (NTx, expressed as ratio to creatinine) at 26 weeks. Analysis included all randomly assigned participants who completed follow-up. Groups were compared with analysis of covariance with Hochberg testing. Secondary endpoints were other biochemical markers of bone turnover, bone mineral density, short physical performance battery, and grip strength. Mechanistic endpoints were glutathione peroxidase, highly sensitive C-reactive protein, and interleukin-6. This trial is registered with EU clinical trials, EudraCT 2016-002964-15, and ClinicalTrials.gov, NCT02832648, and is complete. Findings 120 participants were recruited between Jan 23, 2017, and April 11, 2018, and randomly assigned to selenite 200 μg, 50 μg, or placebo (n=40 per group). 115 (96%) of 120 participants completed follow-up and were included in the primary analysis (200 μg [n=39], 50 μg [n=39], placebo [n=37]). Median follow-up was 25·0 weeks (IQR 24·7–26·0). In the 200 μg group, mean serum selenium increased from 78·8 (95% CI 73·5–84·2) to 105·7 μg/L (99·5–111·9). Urine NTx to creatinine ratio (nmol bone collagen equivalent:mmol creatinine) did not differ significantly between treatment groups at 26 weeks: 40·5 (95% CI 34·9–47·0) for placebo, 43·4 (37·4–50·5) for 50 μg, and 42·2 (37·5–47·6) for 200 μg. None of the secondary or mechanistic endpoint measurements differed between treatment groups at 26 weeks. Seven (6%) of 120 participants were withdrawn from treatment at week 13 due to abnormal thyroid-stimulating hormone concentrations (one in the 200 μg group, three in the 50 μg group, and three in the placebo group) and abnormal blood glucose (one in the 50 μg group). There were three serious adverse events: a non-ST elevation myocardial infarction at week 18 (in the 50 μg group), a diagnosis of bowel cancer after routine population screening at week 2 (in the placebo group), and a pulmonary embolus due to metastatic bowel cancer at week 4 (in the 200 μg group). All severe adverse events were judged by the principal investigator as unrelated to trial medication. Interpretation Selenium supplementation at these doses does not affect musculoskeletal health in postmenopausal women

Parton distributions in the virtual photon target up to NNLO in QCD

Parton distributions in the virtual photon target are investigated in perturbative QCD up to the next-to-next-to-leading order (NNLO). In the case $\Lambda^2 \ll P^2 \ll Q^2$, where $-Q^2$ ($-P^2$) is the mass squared of the probe (target) photon, parton distributions can be predicted completely up to the NNLO, but they are factorisation-scheme-dependent. We analyse parton distributions in two different factorisation schemes, namely $\bar{\rm MS}$ and ${\rm DIS}_{\gamma}$ schemes, and discuss their scheme dependence. We show that the factorisation-scheme dependence is characterised by the large-$x$ behaviours of quark distributions. Gluon distribution is predicted to be very small in absolute value except in the small-$x$ region.Comment: 28 pages, 5 figures, version to appear in Eur. Phys. J.

The effect of carbohydrate ingestion on the motor skill proficiency of soccer players

This study examined the effects of ingesting a glucose-polymer (GP) solution on the motor skill proficiencies of association football (soccer) players from two teams playing during two matches in a cool environment. Fifteen minutes before each match and at halftime, players from both teams ingested 5 ml/kg of either placebo or a 6.9% GP solution. GP ingestion did not improve tackling, heading, dribbling, or shooting ability. On the contrary, the mean of successful tackles was lower with GP ingestion than with placebo. The success rate for heading, dribbling, and shooting also tended to be lower in the GP than in the placebo condition. In contrast, success in passing and ball control was similar in the two conditions. Improvements in passing and ball control may have been related to a decrease in the intensity of play in the second half of the game. These data indicate that there are no measurable benefits of GP ingestion for the motor skill proficiencies of soccer players during games played in a cool environment.IS

Spatial prediction of the concentration of selenium (Se) in grain across part of Amhara Region, Ethiopia

Grain and soil were sampled across a large part of Amhara, Ethiopia in a study motivated by prior evidence of selenium (Se) deficiency in the Region's population. The grain samples (teff, Eragrostis tef, and wheat, Triticum aestivum) were analysed for concentration of Se and the soils were analysed for various properties, including Se concentration measured in different extractants. Predictive models for concentration of Se in the respective grains were developed, and the predicted values, along with observed concentrations in the two grains were represented by a multivariate linear mixed model in which selected covariates, derived from remote sensor observations and a digital elevation model, were included as fixed effects. In all modelling steps the selection of predictors was done using false discovery rate control, to avoid over-fitting, and using an α-investment procedure to maximize the statistical power to detect significant relationships by ordering the tests in a sequence based on scientific understanding of the underlying processes likely to control Se concentration in grain. Cross-validation indicated that uncertainties in the empirical best linear unbiased predictions of the Se concentration in both grains were well-characterized by the prediction error variances obtained from the model. The predictions were displayed as maps, and their uncertainty was characterized by computing the probability that the true concentration of Se in grain would be such that a standard serving would not provide the recommended daily allowance of Se. The spatial variation of grain Se was substantial, concentrations in wheat and teff differed but showed the same broad spatial pattern. Such information could be used to target effective interventions to address Se deficiency, and the general procedure used for mapping could be applied to other micronutrients and crops in similar settings