A literature review on osteoporosis risk factors and prevention: the importance of an early approach

Osteoporosis is a condition characterized by deterioration of bone microarchitecture resulting in loss of total bone mass, decreased tissue resistance and increased susceptibility to fractures. The study in question aimed to analyze and debate the risk factors and the effectiveness of forms of prevention related to osteoporosis, given their implication for the general population and the need to disseminate safe and effective forms of behavioral management that can contribute to the decrease in the condition, mainly in the most susceptible individual. For this, 42 articles indexed in Bireme, PubMed, Scielo and UpToDate platforms were selected for discussion of the topic. Thus, it was concluded that the need for active investigation of risk factors by health professionals, as well as the encouragement of preventive practices, especially in the population with higher incidence of the disease.

Fabry-Perot interference pattern scattered by a sub-monolayer array of nanoparticles

Understanding scattering of visible and infrared photons from nanomaterials and nanostructured materials is increasingly important for imaging, thermal management, and detection, and has implications for other parts of the electromagnetic spectrum (e.g., x-ray scattering and radar). New, interesting reports of photon scattering as a diagnostic probe, from inelastic x-ray scattering and interference to “nano-FTIR” microscopy using infrared photons, have been published and are under active investigation in laboratories around the world. Here, we report, for the first time to our best knowledge, the experimental discovery of a Fabry-Perot interference pattern that is scattered by the sub-monolayer array of plasmonic Ag nanoparticles, and confirm it analytically and with rigorous numerical FDTD simulations.

Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

The complex pathophysiologic interplay between SARS-CoV-2 infection and complement activation is the subject of active investigation. It is clinically mirrored by the occurrence of exacerbations of complement mediated diseases during COVID-19 infection. These include complement-mediated hemolytic anemias such as paroxysmal nocturnal hemoglobinuria (PNH), autoimmune hemolytic anemia (AIHA), particularly cold agglutinin disease (CAD), and hemolytic uremic syndrome (HUS). All these conditions may benefit from complement inhibitors that are also under study for COVID-19 disease. Hemolytic exacerbations in these conditions may occur upon several triggers including infections and vaccines and may require transfusions, treatment with complement inhibitors and/or immunosuppressors (i.e., steroids and rituximab for AIHA), and result in thrombotic complications. In this manuscript we describe four patients (2 with PNH and 2 with CAD) who experienced hemolytic flares after either COVID-19 infection or SARS-Cov2 vaccine and provide a review of the most recent literature. We report that most episodes occurred within the first 10 days after COVID-19 infection/vaccination and suggest laboratory monitoring (Hb and LDH levels) in that period. Moreover, in our experience and in the literature, hemolytic exacerbations occurring during COVID-19 infection were more severe, required greater therapeutic intervention, and carried more complications including fatalities, as compared to those developing after SARS-CoV-2 vaccine, suggesting the importance of vaccinating this patient population. Patient education remains pivotal to promptly recognize signs/symptoms of hemolytic flares and to refer to medical attention. Treatment choice should be based on the severity of the hemolytic exacerbation as well as of that of COVID-19 infection. Therapies include transfusions, complement inhibitor initiation/additional dose in the case of PNH, steroids/rituximab in patients with CAD and warm type AIHA, plasma exchange, hemodialysis and complement inhibitor in the case of atypical HUS. Finally, anti-thrombotic prophylaxis should be always considered in these settings, provided safe platelet counts.

Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms

Cardiac reperfusion injury is a well-established outcome following treatment of acute myocardial infarction and other types of ischemic heart conditions. Numerous cardioprotection protocols and therapies have been pursued with success in pre-clinical models. Unfortunately, there has been lack of successful large-scale clinical translation, perhaps in part due to the multiple pathways that reperfusion can contribute to cell death. The search continues for new cardioprotection protocols based on what has been learned from past results. One class of cardioprotection protocols that remain under active investigation is that of controlled reperfusion. This class consists of those approaches that modify, in a controlled manner, the content of the reperfusate or the mechanical properties of the reperfusate (e.g., pressure and flow). This review article first provides a basic overview of the primary pathways to cell death that have the potential to be addressed by various forms of controlled reperfusion, including no-reflow phenomenon, ion imbalances (particularly calcium overload), and oxidative stress. Descriptions of various controlled reperfusion approaches are described, along with summaries of both mechanistic and outcome-oriented studies at the pre-clinical and clinical phases. This review will constrain itself to approaches that modify endogenously-occurring blood components. These approaches include ischemic postconditioning, gentle reperfusion, controlled hypoxic reperfusion, controlled hyperoxic reperfusion, controlled acidotic reperfusion, and controlled ionic reperfusion. This review concludes with a discussion of the limitations of past approaches and how they point to potential directions of investigation for the future.

Real-world walking economy: can laboratory equations predict field energy expenditure?

We addressed a practical question that remains largely unanswered after more than a century of active investigation: can equations developed in the laboratory accurately predict the energy expended under free-walking conditions in the field? Seven subjects walked a field course of 6415 meters that varied in gradient (-3.0 to +5.0%) and terrain (asphalt, grass) under unloaded (body weight only, Wb) and balanced, torso-loaded (1.30 x Wb) conditions at self-selected speeds while wearing portable calorimeter and GPS units. Portable calorimeter measures were corrected for a consistent measurement-range offset (+13.8±1.8%, mean±sd) vs. a well-validated laboratory system (Parvomedics TrueOne). Predicted energy expenditure totals (mls O2/kg) from four literature equations: ACSM, Looney, Minimum Mechanics and Pandolf, were generated using the speeds and gradients measured throughout each trial in conjunction with empirically determined terrain/treadmill factors (asphalt=1.0, grass=1.08). The mean energy expenditure total measured for the unloaded field trials (981±91 mls O2/kg) was over-predicted by +4%, +13%, +17% and +20% by the Minimum Mechanics, ACSM, Pandolf, and Looney equations, respectively (corresponding predicted totals: 1018±19, 1108±26, 1145±37, and 1176±24 mls O2/kg). The measured loaded-trial total (1310±153 mls O2/kg) was slightly under-predicted by the Minimum Mechanics equation (-2%, 1289±22 mls O2/kg) and over-predicted by the Pandolf equation (+13%, 1463±32 mls O2/kg). Computational comparisons for hypothetical trials at different constant speeds (range: 0.6-1.8 m/s) on variable-gradient loop courses revealed between-equation prediction differences from 0 to 37%. We conclude that treadmill-based predictions of free-walking field energy expenditure are equation-dependent but can be highly accurate with rigorous implementation.

Stereotactic Laser Ablation (SLA) Followed by Consolidation Stereotactic Radiosurgery (cSRS) as Treatment for Brain Metastasis that Recurred Locally After Initial Radiosurgery (BMRS): A Multi-Institutional Experience

Introduction: The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation. Here, we report outcomes for patients with BMRS treated with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy, LITT)followed by consolidation radiosurgery (cSRS). Methods: Clinical outcome of 20 patients with 21histologically confirmed BMRS treated with SLA followed by consolidation SRS and >6 months follow-up were collected retrospectively across three participating institutions. Results: Consolidation SRS (5 Gy x 5 or 6 Gy x 5) wascarried out 16-73 days (median of 26 days) post-SLA of BMRS. There were no new neurological deficits after SLA/cSRS. While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after SLA, no KPS declines was observed after cSRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of cSRS (severe headache that resolved with steroid therapy (n=1) and new onset seizure (n=1)). With a median follow-up of 228 days (range: 178-1367 days), the local control rate at 6 and 12 months (LC6, LC12) was 100%. All showed diminished FLAIR volume surrounding the SLA/cSRS treated BMRS at the six-month follow-up; none of the patients required steroid for symptoms attributable to these BMRS. These results compare favorably to the available literature for repeat SRS or SLA-only treatment of BMRS.Conclusions: This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategyfor BMRS.

The Expanding Role of Quantitative Pupillometry in the Evaluation and Management of Traumatic Brain Injury

Traumatic brain injury is a rapidly increasing source of morbidity and mortality across the world. As such, the evaluation and management of traumatic brain injuries ranging from mild to severe are under active investigation. Over the last two decades, quantitative pupillometry has been increasingly found to be useful in both the immediate evaluation and ongoing management of traumatic brain injured patients. Given these findings and the portability and ease of use of modern pupillometers, further adoption and deployment of quantitative pupillometers into the preclinical and hospital settings of both resource rich and medically austere environments.

The Diabetic Cardiomyopathy: The Contributing Pathophysiological Mechanisms

Individuals with diabetes mellitus (DM) disclose a higher incidence and a poorer prognosis of heart failure (HF) than non-diabetic people, even in the absence of other HF risk factors. The adverse impact of diabetes on HF likely reflects an underlying “diabetic cardiomyopathy” (DM–CMP), which may by exacerbated by left ventricular hypertrophy and coronary artery disease (CAD). The pathogenesis of DM-CMP has been a hot topic of research since its first description and is still under active investigation, as a complex interplay among multiple mechanisms may play a role at systemic, myocardial, and cellular/molecular levels. Among these, metabolic abnormalities such as lipotoxicity and glucotoxicity, mitochondrial damage and dysfunction, oxidative stress, abnormal calcium signaling, inflammation, epigenetic factors, and others. These disturbances predispose the diabetic heart to extracellular remodeling and hypertrophy, thus leading to left ventricular diastolic and systolic dysfunction. This Review aims to outline the major pathophysiological changes and the underlying mechanisms leading to myocardial remodeling and cardiac functional derangement in DM-CMP.

Case Report: Sars-CoV-2 Infection in a Vaccinated Individual: Evaluation of the Immunological Profile and Virus Transmission Risk

During the COVID19 pandemic, a range of vaccines displayed high efficacy in preventing disease, severe outcomes of infection, and mortality. However, the immunological correlates of protection, the duration of immune response, the transmission risk over time from vaccinated individuals are currently under active investigation. In this brief report, we describe the case of a vaccinated Healthcare Professional infected with a variant of Sars-CoV-2, who has been extensively investigated in order to draw a complete trajectory of infection. The patient has been monitored for the whole length of infection, assessing the temporal viral load decay, the quantification of viral RNA and subgenomic mRNA, antibodies (anti Sars-CoV-2, IgA, IgG, IgM) and cell-mediated (cytokine, B- and T-cell profiles) responses. Overall, this brief report highlights the efficacy of vaccine in preventing COVID19 disease, accelerating the recovery from infection, reducing the transmission risk, although the use of precautionary measures against Sars-CoV-2 spreading still remain critical.

SPT6 promotes epidermal differentiation and blockade of an intestinal-like phenotype through control of transcriptional elongation

In adult tissue, stem and progenitor cells must tightly regulate the balance between proliferation and differentiation to sustain homeostasis. How this exquisite balance is achieved is an area of active investigation. Here, we show that epidermal genes, including ~30% of induced differentiation genes already contain stalled Pol II at the promoters in epidermal stem and progenitor cells which is then released into productive transcription elongation upon differentiation. Central to this process are SPT6 and PAF1 which are necessary for the elongation of these differentiation genes. Upon SPT6 or PAF1 depletion there is a loss of human skin differentiation and stratification. Unexpectedly, loss of SPT6 also causes the spontaneous transdifferentiation of epidermal cells into an intestinal-like phenotype due to the stalled transcription of the master regulator of epidermal fate P63. Our findings suggest that control of transcription elongation through SPT6 plays a prominent role in adult somatic tissue differentiation and the inhibition of alternative cell fate choices.