Search

In men with idiopathic osteoporosis, histomorphometric studies reported both increased resorption and decreased remodeling. We aimed at examine bone remodeling in these patients by biological marker measurement. We compared pre-treatment carboxy-terminal cross-linking telopeptide of type I collagen (CTX) and bone alkaline phosphatase (bALP) levels in 49 men, mean age 59 ± 14 year, with idiopathic osteoporosis with fractures (40 patients) or osteoporosis diagnosed by densitometry (9 patients) with 50 age-matched controls. The influence of baseline remodeling level on alendronate efficacy was studied. Bone remodeling markers (CTX and bALP) did not significantly differ between patients and controls and were correlated in both groups. There was no correlation between these markers, vitamin D and PTH levels. Twenty-one patients underwent repeat densitometry after 1 year of alendronate (70 mg/week). Mean annual BMD increase, spine +4.1 ± 3.9%, and hip +1.5 ± 1.2% showed no correlation with baseline CTX. Bone remodeling is very heterogeneous and formation and resorption remain biologically coupled in both idiopathic male osteoporosis and controls. Baseline remodeling level does not affect the action of alendronate on BMD.

This chapter develops the major components of web atmospherics (Richard, 2005). In retailing research, retail atmospherics (e.g., scents, color, design) are very important to the success of retailers. Similarly, Richard (2005) demonstrates that web atmospherics are important to the development of positive attitudes toward the website and the products it describes. In Figure 1, these are the shaded areas.

This chapter concludes the model of internet consumer behavior by describing some key moderating variables such as gender, need for cognition (NFC) and optimum stimulation level (OSL)(Figure 1).

Objectives Bent spine syndrome (BSS) is characterized by involuntary forward flexion of the trunk in the standing position but not in the recumbent position. We assessed the causes of BSS based on findings in 63 patients. Methods We retrospectively reviewed the records of all patients with BSS evaluated at a teaching hospital in Toulouse, France, between 1995 and 2006. For each patient, we recorded the findings from the following investigations: physical examination, electromyogram (EMG), creatine phosphokinase (CPK) assay, computed tomography (CT), and surgical muscle biopsy. Results We identified 63 patients, 46 females and 17 males, with a mean age of 70 ± 6.9 years. Among them, 40 had delayed-onset paraspinal myopathy, with fatty infiltration predominantly affecting the paraspinal muscles. In 40% of these patients, CT disclosed mild fatty infiltration of the gluteal and posterior thigh and leg muscles in addition to the paraspinal muscle abnormalities. Paraspinal muscle histology showed lobular endomysial fibrosis, as previously described and ruled out other forms of muscle dystrophy. The remaining 23 patients (14 females and nine males) had either another neurological disease or myopathic involvement of other muscles, with a definite diagnosis; nevertheless, forward bending of the trunk was the most prominent symptom and the reason for the initial physician visit. Conclusion In our case-series, delayed-onset paraspinal myopathy accounted for 64% of cases of BSS. The most informative investigation was CT, which showed a patchy decrease in paraspinal muscle density.

UNLABELLED So far, only one study has demonstrated a high incidence of vitamin D deficiency in patients with multiple myeloma. Vitamin D deficiency may alter bone remodelling in myeloma. In this study, we aimed to determine the prevalence of vitamin D deficiency and to assess its impact on bone remodelling and bone mineral density before and after autologous stem cell transplantation (ASCT). PATIENTS AND METHODS In 39 consecutive patients receiving high-dose chemotherapy (melphalan 200 mg/m(2)) followed by ASCT for multiple myeloma, we measured before (T0) and 12 months after ASCT (T12) serum calcium, 25-OH-D, PTH 1-84, bone alkaline phosphatase (bALP), serum C-terminal cross-linking telopeptide and lumbar spine bone mineral density (BMD). RESULTS Mean vitamin D levels were low: 15 +/- 5 ng/mL (9-18) at T0 and 16 +/- 5 ng/mL (14-22) at T12. Twenty-six patients (68%) had vitamin D deficiency (25-OH-D < 20 ng/mL) at T0 and 58% at T12. Patients in the vitamin D-deficient group had higher serum PTH levels than those in the vitamin D-sufficient group : 71 +/- 24 pg/mL vs. 52 +/- 18 pg/mL (P = 0.04). Biochemical bone markers were identical in both groups at T0 and T12. Z-score values did not significantly differ between the two groups at T0 and T12. There were no correlations between 25-OH-D and BMD or bone marker levels. CONCLUSION Vitamin D deficiency does not impair biochemical markers of bone metabolism in patients with multiple myeloma, before or after ASCT.

International audience; The management of osteoporosis has improved considerably, leading to the development of new goals. A major concern today is the management of patients with severe osteoporosis, in whom the need for pharmacotherapy is clear [1]. Epidemiological data have established that osteoporosis is associated with severe complications [2,3]. Furthermore, osteoporosis is now recognized as a complication of several chronic diseases, whose presence adversely affects the management of osteoporosis. The ODISSEE task force (Osteoporosis DIagnosis and Surveillance of SEvErity) was established to answer practical questions regarding the management of severe osteoporosis, based on evidence in the literature. Several groups conducted an exhaustive literature review, and advice was obtained from a panel of French rheumatologists. The ODISSEE scientific committee then developed the first consensus statement on the diagnosis, follow-up and management of severe osteoporosis. This statement was validated by a panel of 70 French rheumatologists at the first national ODISSEE meeting held on November 13-14, 2009.

A trial was initiated to determine the feasibility and efficacy of a three-phase treatment including: (1) induction chemotherapy (IC); (2) high-dose melphalan with total body irradiation supported by unpurged autologous bone marrow transplantation (ABMT); and (3) interferon (IFN) alpha maintenance treatment, in previously untreated aggressive myeloma. Thirty-five consecutive patients, ages under 65 years, were enrolled. Initial induction therapy was randomized between the VAD regimen (vincristine, doxorubicin, dexamethasone) or the VMCP regimen (vincristine, melphalan, cyclophosphamide, prednisone) that were found to give similar results as IC. Thirty-one of 35 (89%) patients, with good performance status and normal renal function after IC, received ABMT. IFN alpha was started soon after ABMT and was well tolerated. Fifteen of 35 (43%) patients achieved complete response (CR) and 14 of 35 (40%) achieved partial response (PR). Low pretreatment beta 2 microglobulin was the only predictive factor for accomplishing CR. The duration of response was significantly affected by the magnitude of response. The 33-month, post-ABMT probability of progression-free survival was 85% for patients in CR versus 24% for patients in PR. The 42-month, post-diagnosis probability of survival was 81%. This overall strategy may represent an advance in the management of multiple myeloma. Furthermore, the high rate and long duration of CR that we observed in patients with low beta 2 microglobulin suggest that such patients may preferentially benefit from this strategy.

Using an index of English‐French Canadian ethnicity developed on the basis of language use in various social communication situations, this study investigates the relationship between ethnicity and use (ownership) of several financial services. A significant result is found in all cases even after removing the effects of income, family life cycle and size.

Fibroblast growth factor 23 (FGF23), a recently discovered phosphaturic substance playing a key role in genetic and oncogenic phosphate diabetes, is involved in the physiological regulation of phosphate metabolism. Moderate idiopathic phosphate diabetes (IPD) leading to male osteoporosis and diffuse pain resembling fibromyalgia has been described. The aim of our study was to define the role of FGF23 in the mechanism of IPD. The study concerned 29 patients with IPD, mean age 53 +/- 11 years, of whom 72% were men. Fifteen subjects without bone disease and with normal serum phosphate and calcium levels were used as controls. Phosphate diabetes was confirmed by phosphate reabsorption level

Objective: The aim of this review of the literature is to report the factors which both contribute to the frailty syndrome and increase hip fracture risk in the elderly. This work is the fruit of common reflection by geriatricians, endocrinologists, gynecologists and rheumatologists, and seeks to stress the importance of detection and management of the various components of frailty in elderly subjects who are followed and treated for osteoporosis. It also sets out to heighten awareness of the need for management of osteoporosis in the frail elderly.Design: The current literature on frailty and its links with hip fracture was reviewed and discussed by the group.Results: The factors and mechanisms which are common to both osteoporosis and frailty (falls, weight loss, sarcopenia, low physical activity, cognitive decline, depression, hormones such as testosterone, estrogens, insulin-like growth factor-I (IGF-I), growth hormone (GH), vitamin D and pro-inflammatory cytokines) were identified. The obstacles to access to diagnosis and treatment of osteoporosis in the frail elderly population and common therapeutic pathways for osteoporosis and frailty were discussed.Conclusion: Future research including frail subjects would improve our understanding of how management of frailty can can contribute to lower the incidence of fractures. In parallel, more systematic management of osteoporosis should reduce the risk of becoming frail in the elderly population.

This study proposes an index measure of English-French Canadian ethnicity accounting for the varying degrees of aculturation on the basis of communication pattern of individuals. The index, after a limited validation check, is then applied in the area of leisure consumption behavior to explore its moderating effect.

Since the results of the ATAC study, women who have undergone surgery for breast cancer and who require adjuvant hormone therapy are often treated with aromatase inhibitors. With these treatments, joint pain is frequent (30% to 40%) and quite often disabling (5% to 10%). Our objective was to investigate the origin of the pain induced by the anti-aromatases.Twenty-four women of mean age 59 years with joint pain of5/10 on a visual analog scale underwent a rheumatological consultation and systematic laboratory tests.In 5 patients, pain was considered to have a well defined cause: osteoarthritis, shoulder tendinitis, or paraneoplastic aponeurositis. The other 19 patients had inflammatory pain of the fingers, wrists, shoulders, forefeet, ankles, or knees, with slight synovial thickening of the PIP and MCP joints. Two had an inflammatory syndrome on laboratory tests. Nine of these patients had antinuclear antibodies (ANA1/160 on HEp-2 cells) and 4 had rheumatoid factors (20 U). Ten patients had sicca syndrome of the eyes or mouth, 7 had probable Sjögren's syndrome according to the San Diego criteria, and one had definite Sjögren's syndrome. One had rheumatoid arthritis, one had Hashimoto thyroiditis, and 2 had positive hepatitis C serology.Is the almost total estrogen depletion induced by aromatase inhibitors conducive to the development of sicca syndromes with ANA? Our results should be considered in relation to the Sjögren-like syndromes occurring in aromatase knock-out mice as recently reported.

Several authors have described the association of ankylosing spondylitis (AS) and osteoporosis. Usually vertebral fractures complicate severe AS.We report a series of 10 men in whom benign spondyloarthropathy was discovered during etiological investigation for osteoporosis. Eight patients had B27+ AS and 2 had psoriatic arthritis with axial involvement. The mean number of vertebral fractures was 1.5. No patient had an appendicular fracture.Phosphorus and calcium levels and measurements of 25OHD3, parathyroid hormone, osteocalcin, and serum CTX were in the normal range. The decrease in bone mineral density was greater in the spine (mean T-score at L2-L4 -2.95, mean total hip T-score -1.67).Osteoporosis with fractures may reveal benign spondyloarthropathy whose clinical expression is sometimes incomplete. Our findings demonstrate that osteoporosis is not always correlated with the severity of AS.

A 23-year-old man presented with osteoporosis, revealed by femoral fractures, and a history of nephrolithiasis, short stature, metabolic acidosis, hypokalemia and ovalocytosis, a red blood cell abnormality common in malaria endemic regions. Biological investigations led to the diagnosis of type 1 distal renal tubular acidosis (dRTA). Ovalocytosis and dRTA may co-exist in the same patient, since both can originate in mutations of the anion-exchanger 1 (AE1) gene, which codes for band 3, the bicarbonate/chloride exchanger, present in both the red cell membrane and the basolateral membrane of the collecting tubule alpha-intercalated cell.

Drawing on categorization theory, this empirical study focuses on the critical role of congruency in prototypical brand extensions. A survey, measuring reactions to 18 proposed extensions involving six well-known brands (Xerox, Kleenex, Band-Aid, Scotch-Tape, Coke, Sony Walkman), was administered to a sample of graduate students. For each prototypical brand, there were three proposed extensions: congruent, moderately congruent, and incongruent. Preliminary analyses, using a series of MANOVAs and post-hoc pairwise difference tests, revealed robust variations across the six brands with respect to the level of extension congruency. Using multiple-item indicators for three latent constructs (attitude towards parent brand, extension fit, and extension success) along with two additional variables (prototypicality and manufacturing complexity), we developed and tested three structural equation models linking these aforementioned variables, for congruent, moderately congruent, and incongruent extensions. Results indicate that—irrespective of the level of extension congruency—perceptions of fit had the strongest influence on extension success. However, while parent-brand affect directly and indirectly influenced success for congruent brand extensions, these parent-brand associations played no significant role for moderately congruent and incongruent brand extensions. Implications for brand managers and directions for future research are also discussed.

Prostatic biopsy is a routine clinical procedure often wrongly considered to be perfectly harmless. The authors report the first case of epidural abscess after prostatic biopsy, despite properly conducted antibiotic prophylaxis. Although the epidural space is a known site of infection, the relationship with prostatic biopsies has never been previously reported. This clinical case emphasizes the need for complete patient information and the importance of anti-infective prophylaxis guidelines.

Remitting seronegative symmetrical synovitis pitting oedema (RS3PE) is a distinct form of seronegative rheumatoid arthritis like polyarthritis. It is characterized by late onset symmetrical joint involvement and pitting oedema of hands and feet (JAMA 254(19):2763-2767, [1]). Polyarthritis secondary to intravesical Bacillus Calmette Guerin (BCG) therapy has been reported (Clin Rheumatol 21:536-537, [2]). To our knowledge, about 0.5% of patients receiving BCG instillation presented polyarthritis, but only one case of RS3PE has been reported (J Rheumatol 28:1699-1701, [3]). We described the second case of RS3PE following intravesical BCG instillation of bladder carcinoma.

PurposeTo examine the impact of culture on customer service expectations, specifically, how individualists and collectivists use internal and external sources of information to formulate their service expectations.Design/methodology/approachThe context was the airline industry and the subject pool consisted of experienced consumers. A survey was employed to measure individualism/collectivism, various internal/external information sources, and the functional and technical dimensions of “should” and “will” service expectations. Hypothesized relationships were tested using a structural equations modeling approach.FindingsBoth individualists and collectivists relied more on external information sources in formulating their service expectations, gave variable weight to the functional and technical components, and used more realistic “will” expectations to judge service offerings. Internal (external) information sources were relatively more important in forming expectations for collectivists (individualists) than for individualists (collectivists), and “will” (“should”) expectations were more diagnostic for collectivists (individualists) than for individualists (collectivists).Research limitations/implicationsGeneralizability of the findings is limited due to the specific industry under study (airlines), the sample (two geographically‐proximate sub‐cultures), and the scope of the cultural variables considered (individualism/collectivism).Practical implicationsWhether managers should leverage the functional and/or technical components of services depends in part on the cultural orientation of their customers. Managers should also recognize that customers’ usage of various information sources in forming service expectations is also, in part, culturally determined.Originality/valueIn this era of globalization, researchers and managers alike need to consider the subtle influences of culture on marketing theories and the formulation of service expectations respectively.

International audience; Cells of four reference strains (Scott A, LO 28, CNL 895807 and ATCC 19115) and of five recent food isolates (A00M011, A00M018, A00M087, A00M092 and A00M123) of Listeria monocytogenes were grown until late exponential phase in Brain Heart Broth at two different temperatures (37 degrees C and 4 degrees C). Our results show that significant differences exist between the cellular lipid fatty acid profile of reference and recent food isolates. Like the reference strains, and in keeping with previous reports on the cellular lipid fatty acid profile of L. monocytogenes, the recent food isolates were characterised by the presence of ai15:0, i15:0 and ai17:0. In addition, the fatty acid ai13:0 was observed in all of the recent food isolates grown at 4 degrees C, whereas only two reference strains, Scott A and LO 28, showed ai13:0 in their cellular lipid fatty acid profile at 4 degrees C. When grown at 4 degrees C, the recent food isolates showed a mean aiC15/aiC17 ratio of 66, while reference strains were characterised by significantly lower ratios, ranging between 4.3 (ATCC 19115) and 28.9 (Scott A). These results showed that all of the recent food isolates, Scott A and LO28 strains use chain length and anteiso-branching (ai15:0) as their major response to cold temperature adaptation. However, the cold adaptation response of reference strains CNL 895807 and ATCC 19115 appears to be different.

PurposeThe purpose of this research was to examine the impact of various attitudes and personality characteristics on environmentally‐friendly behaviors, from a locus of control (LOC) perspective. Specifically, we developed and tested a model linking a related construct, environmental locus of control (ELOC), to a series of pro‐environmental behaviors.Design/methodology/approachThe context related to various personal and household behaviors vis‐à‐vis the environment, and the subject pool consisted of a diverse group of urban consumers. A survey was employed to measure various attitudinal and personality variables corresponding to internal/external locus of control, as well as a battery of pro‐environmental behaviors. The research propositions were tested using a structural equation modeling approach.FindingsWe found four distinct dimensions of ELOC, two of which relate to an external LOC (“biospheric‐altruism” and “corporate skepticism”) and the other two relate to an internal LOC (“economic motivation” and “individual recycling efforts”). We then linked these four dimensions to a variety of pro‐environmental behaviors. Highly variable patterns were obtained, with different dimensions assuming a greater or lesser impact, or no role at all, depending on the specific behavior under analysis.Research limitations/implicationsGeneralizability of the findings is limited due to the sample (urban consumers from one major city), and the method employed (validity of self‐report measures and the non‐experimental nature of the field study).Practical implicationsOur findings highlight the importance of considering the specificity of pro‐environmental behaviors, when assessing the antecedent roles of pro‐environmental attitudes/dispositions, which are in‐and‐of‐themselves, complex and multidimensional.Originality/valueIn this era of environmental degradation, researchers, managers, and public policy makers alike need to consider that pro‐environmental attitudes are composed of multiple dispositional facets, and that the role of these facets is highly context‐specific.

The authors investigated the impact of ethnic change experienced by Chinese Canadian couples on gender-role attitude, household task-role expectations and performance. The authors presented acculturation and Chinese ethnic identification as the two discriminant facets of ethnic change. Results indicated a nonsignificant role of acculturation in bringing about modifications of the gender-role attitudes of husbands and of their household task-role expectations. In contrast, the acculturation of Chinese Canadian wives proved to be a significant factor in promoting more modern (less traditional) gender-role attitudes, which in turn led to role expectations that they should contribute less to the performance of the tasks that traditionally fall in the female domain whereas their husbands should contribute more. Subsequent results also revealed that the acculturation of wives was directly linked to the role expectation that they should assume a greater share of responsibility in taking care of the traditionally husband-responsible tasks whereas their husbands should contribute a smaller share. Moreover, Chinese ethnic identification emerged as a significant determinant of husbands' gender-role attitudes and influenced their role expectation that husbands should contribute more to the performance of the tasks that traditionally fall in the male domain whereas their wives should contribute less.

Campylobacter are a leading cause of human diarrhea. The usual source of infection is contaminated food, particularly poultry but pork has also been described. The veterinary use of antimicrobial drugs has been suggested to be largely responsible for resistance in human isolates of this zoonotic pathogen. A study was carried out to investigate the occurrence and antimicrobial resistance of Campylobacter isolated from French fattening pigs. From March 1998 to June 1999, stomach samples were collected at slaughter from 240 fattening pigs originating from 24 different farms. Half of the pigs were found to be positive for Campylobacter but considerable variation was observed between farms. Isolates all belong to the Campylobacter coli species. Susceptibilities of the strains were determined for five antimicrobial drugs using agar dilution. Resistance to tetracycline and erythromycin was high (79 and 55%, respectively). For nalidixic acid, enrofloxacin and ampicillin, resistance was observed in 34, 15 and 20% of the isolates, respectively. More than one-third of the strains was resistant to at least three antimicrobial drugs. A Thr86Ile modification in GyrA was observed in the enrofloxacin-resistant strains studied. The multiresistant strains analyzed expressed the multidrug transporter CmeB at a high level. Results indicated a high prevalence of C. coli in the stomach of the French pigs examined. In addition, a high proportion of the strains was resistant to antimicrobial drugs, particularly to tetracycline and erythromycin, or were multiresistant.

This exploratory study examines the underlying determinants as well as the dimensionality of in-store information searches for a Christmas clothing gift, focusing specifically on the differential effect of gender on information acquisition. A self-administered survey, containing personality, situational and standard demographic measures, was administered to actual consumers in three Western countries, shortly after the Christmas season. Confirmatory factor analysis verified that in-store information is indeed a multidimensional construct, composed of three distinct factors: macro information search, micro information search and salesperson help. Consistent with expectations, compared to males, females tended to acquire macro and micro information to a greater extent; males were more apt to seek the assistance of store sales personnel than females. This pattern was generally robust across the three countries. Other observed gender and/or country-sample differences are discussed. Copyright © 2002 Henry Stewart Publications Ltd.

Avascular osteonecrosis of the femoral head (AONFH) usually goes through the four stages described by Arlet and Ficat: normal radiographs, heterogeneity and sclerosis of the femoral head, subchondral fracture with an individualized sequestrum, and secondary osteoarthritis. Arlet and Ficat individualized a specific pattern of AONFH which they called ischemic hip disease, in which cartilage damage seen as concentric joint space loss precedes the bony alterations. Although radiological and pathological studies of ischemic hip disease have been published, no clinical data are available. We report the case of a 65-year-old man admitted for a 1-month history of severe hip symptoms with concentric joint space loss but no osteophytes. Laboratory tests and examination of fluid aspirated from the hip ruled out septic arthritis and inflammatory hip disease. Two magnetic resonance imaging (MRI) studies done 1 month apart showed diffuse edema involving not only the femoral head but also the neck and trochanter, as well as major synovial hypertrophy. This atypical MRI appearance prompted synovial membrane and pertrochanteric core biopsies, which showed reactive synovitis and stage IV osteonecrosis, respectively. The pain, disability, and joint space loss worsened. Total hip arthroplasty was performed 1 month after the biopsy. Histological examination of the femoral head showed diffuse necrosis; no evidence of another condition was found on histological sections of the entire synovial membrane. This case corroborates the hypotheses put forward by Lequesne that some cases of rapidly destructive hip osteoarthritis may be ascribable to ischemia.

A component of ATP, phosphate is at the hub of the energy-related mechanisms operative in muscle cells. Together with calcium, phosphate is involved in bone tissue mineralization: thus, a chronic alteration in the metabolism of phosphate can induce bone and joint disorders. Diagnosis of chronic hypophosphatemia. Serum phosphate, calcium, and creatinine should be assayed simultaneously. Serum calcium is increased in hypophosphatemia caused by hyperparathyroidism and decreased in osteomalacia. Urinary phosphate excretion should be measured in patients with a normal serum calcium level and a serum phosphate level lower than 0.80 mmol/L. A decrease in urinary phosphate excretion to less than 10 mmol/24 h strongly suggests a gastrointestinal disorder, such as malabsorption, antacid use, or chronic alcohol abuse. In patients with a urinary phosphate excretion greater than 20 mmol/24 h, the maximal rate of tubular reabsorption of phosphate (TmPO 4 ) and the ratio of TmPO 4 over glomerular filtration rate (GFR) should be determined to look for phosphate diabetes. Manifestations and causes of phosphate diabetes in adults. Moderately severe phosphate diabetes in adults manifests as chronic fatigue, depression, spinal pain, and polyarthralgia, with osteoporosis ascribable to increased bone resorption. Although many cases are idiopathic, investigations should be done to look for X-linked vitamin D-resistant rickets missed during childhood, a mesenchymatous tumor, or Fanconi’s syndrome with renal wasting of phosphate, glucose, and amino acids. Management of phosphate diabetes. Phosphate supplementation and, in patients with normal urinary calcium excretion, calcitriol produce some improvement in the symptoms and increase the bone mineral density. Whether dipyramidole is clinically effective remains unclear.

Acquired lumbar kyphosis in adults, also called bent spine syndrome (BSS), is probably due to primary tardive myopathy affecting the paraspinal muscles. Objectives. To define family history and other factors associated with BSS, to score functional disability and pain in BSS using visual analog scales (VASs), to determine the pace of disease progression during follow-up, and to define computed tomography (CT) findings comparatively with age- and sex-matched controls. Patients and methods. Twenty-three patients (20 women and three men; mean age, 72.8 years) with a mean disease duration of 8.1 years at presentation and a mean follow-up of 3.5 years underwent a medical interview, a physical examination, and yearly CT scans with muscle density measurement at several vertebral levels (T4, T10, L1, L3, and L5). Results. Mean age at BSS onset was 64.6 years (range, 56–72). In 12 of the 23 cases, a family history of BSS was highly likely. Thirteen patients had performed heavy manual labor at some time during their lives. At completion of follow-up, the mean functional VAS score was 74.5 mm, the mean Eifel score was 16/24, and the mean pain VAS score was 72.4 mm. Mean muscle density obtained by pooling measurements at all vertebral levels was –12.6 ± 31 Hounsfield units (HU) in the patients and +36.9 ± 21 HU in the controls. During the 3.5-year follow-up, the mean loss in muscle density was 6.9 ± 16 HU in the patients; in contrast, no muscle density difference was found between two groups of low back pain patients without BSS aged 65 years and 72 years, respectively (36.2 ± 15 HU vs 38.6 ± 26 HU). Conclusion. BSS causes major functional disability and pain, which worsen over time. The decrease in paraspinal muscle density extends along the entire spine and becomes increasingly marked over time.

To the Editor: Bone infarcts result, probably, from interruption of bone blood flow due to intraosseous arterial thrombosis or hypertrophy of adipocytic cells1. Bone infarcts (denoted as multifocal when more than 5 sites are involved2) have recently been described in HIV-infected patients3. In this context, a relationship with intravenous drug use has been established by some authors4. Buprenorphine marketed under the trade name Subutex® is prescribed for opioid detoxification and subsequent maintenance therapy. It can be administered sublingually, subcutaneously, or intravenously. We describe 4 patients presenting with multifocal bone infarcts in whom buprenorphine abuse was detected. Patient 1, a 36-year-old woman, never pregnant, was a former cocaine addict, but stated she had not taken the drug for 6 years. She had since been treated with oral buprenorphine (Subutex) daily. For 2 years, she had experienced day and night pain of the knees, ankles, and feet. Her alcohol consumption was one or 2 glasses per day. Magnetic resonance imaging (MRI) revealed multifocal infarcts of the distal femoral and proximal … Address correspondence to Prof. M. Laroche, Centre de Rhumatologie, Hopital Purpan, TSA 40031, 31059 Toulouse Cedex 9, France; E-mail:laroche.m{at}chu-toulouse.fr

In order to characterize the abnormalities of bone remodelling in the various stages of plasma cell disorders, we studied 60 patients (29 monoclonal gammopathies of uncertain significance (MGUS), 13 stage I myeloma, 18 stage III myeloma). We carried out histomorphometric study of bone biopsies in 34 patients and measurement of osteocalcin and the calciuria/creatinine ratio. Bone remodelling was approximately normal (BV/TV:21.2 +/- 7, ES:4.1 +/- 2, OS:16.5 +/- 10) in MGUS. Stage I myeloma was characterised by parallel increases in resorption surfaces and osteoid surfaces (BV/TV:18 +/- 5, ES/BS:7.4 +/- 3.5, OS/BS:24.8 +/- 11.5), of the ca/cr ratio and osteocalcin. In stage III myeloma, resorption surfaces and the ca/cr ratio showed an even greater increase while osteoid surfaces, osteocalcin and trabecular bone volume decreased (BV/TV 13.6 +/- 6, ES/BS:12.1 +/- 6, OS/BS:13.6 +/- 8.3). Osteocalcin and osteoid surfaces were correlated (r = 0.5). There was a positive correlation between osteocalcin and the number of plasmocytes in stage 1 myeloma (r = 0.64) and a negative correlation in stage III myeloma (r = 0.9). Bone remodeling was normal in MGUS; bone remodelling grew with a parallel increase of formation and resorption in stage I; bone resorption increased while bone formation decreased in stage III myeloma.

National audience; Les modifications spontanées des caractéristiques au cours du stockage sont un élément déterminant l'acceptabilité et les conditions de commercialisation des produits. Le stockage réfrigéré (jusqu'à 20 jours) et congelé (jusqu'à 9 mois) de truites (salmo trutta) éviscérées et de filets de carpe (cyprinus carpio) crus a été étudié. Les mesures permettant d'évaluer les caractéristiques de texture de la chair (résistance mécanique et hydratation) sont destructives et des poissons différents doivent donc être utilisés pour caractériser les différentes durées de stockage. Pour chaque poisson, un filet est caractérisé cru, le second après chauffage. Au cours du stockage réfrigéré, la résistance mécanique diminue pendant 2 à 3 jours et reste stable ensuite aussi bien pour les filets crus que pour les filets chauffés. Après congélation, les valeurs sont comparables et la durée de stockage ne semble pas avoir une influence marquée. Les autres caractéristiques considérées (couleur, hydratation et pH) ne présentent pas de variations marquées en fonction des conditions de conservation. La variabilité importante de la matière première poisson tend à masquer les effets du stockage qui semblent se résumer, pour les deux espèces considérées, à une diminution de la résistance mécanique pouvant être associée à la résolution de la rigor mortis.

In order to study the action of tiludronate on the changes in intraosseous vascularization induced by ovariectomy, and to link these effects to those observed in bone remodelling, 30 female Sprague-Dawley rats (age 40 weeks) were studied. Ten rats were sham-operated and treated by vehicle, 10 rats were ovariec-tomized and treated by vehicle, and 10 rats were ovariectomized and treated orally with tiludronate, 0.16 mmol/kg/per day, 3 days a week for 16 weeks, from the day following ovariectomy. The rats were killed after 4 months, and a histomorphometric study and quantification of intraosseous vessels carried out on the sixth lumbar vertebra. The area of the intraosseous sinusoidal capillaries increased after ovariectomy, which also induced a moderate increase in resorption surfaces and osteoid surfaces leading to a decrease of 40% in the trabecular bone volume at the lumbar spine level. This bone mineral loss was completely prevented by tiludronate, which normalized the bone turnover. However, tiludronate was without any effect on intraosseous vascularization. These results indicate that the surface area of the intraosseous sinusoidal capillaries was correlated positively with resorption surfaces and negatively with trabecular bone volume and the number of bone trabeculae. In these experimental conditions, an inhibitor of bone resorption can exert its positive effect on bone mass without normalization of vascularization.

International audience; Dans cet article, nous expliquons pourquoi les chercheurs doivent travailler à développer un modèle réaliste de comportement du consommateur et nous proposons quelques solutions qui permettent d'y incorporer la notion de concurrence entre les marques. Nous avons aussi introduit le concept de l'ensemble évoqué et celui de la confiance comme influences sur l'intention d'achat. Le modèle d'intention à effets multiples prend en considération la concurrence dans un marché donné et la confiance dans la marque évoquée pour expliquer l'intention de choisir une marque. Une étude empirique sur les maisons de courtage permet de tester le modèle d'intention à effets multiples sur un échantillon d'utilisateurs de ces firmes. Les résultats obtenus à la suite d'analyses de régressions pas à pas confirment toutes les hypothèses de la recherche, et ils permettent de valider partiellement le modèle proposé.

To the Editor, Some authors have recently reported that teriparatide is effective in the treatment of the bone complications of hypophosphatasia [1, 2]. We report the case of a 43-yearold woman who was treated with teriparatide for 1 year but without effect. Since her childhood, the patient had presented numerous fractures (ribs, pelvis, both femurs) and had migratory arthritis. She was a heterozygous carrier of the N461L mutation in exon 12 of the TNSALP gene. She presented a nondisplaced fracture of the right humeral shaft that was painful and pseudarthrotic in spite of plaster immobilization for 3 months. Treatment was started with teriparatide, 20 lg/day. Fifteen days later, the patient required paracetamol for diffuse bone pain. Ten months after treatment was started, teriparatide was discontinued as bone pain had worsened, and in particular, the humeral pseudarthrosis remained unchanged on X-rays and CT scan. Before treatment, corrected serum calcium was 2.47 mmol/L, serum phosphorus 1.32 mmol/L, 24-hour urinary calcium 4.5 mmol/L, 25OHD 42 ng/mL, parathormone 24 pg/mL, alkaline phosphatase (ALP) 21 IU/L, bone ALP (bALP) \2 mg/L, osteocalcin 17 ng/mL, and serum CTX 178 pg/mL. At treatment discontinuation, serum calcium was 2.70 mmol/L, serum phosphorus 1.40 mmol/L, 24-hour urinary calcium 6.5 mmol/day, 25OHD 38 ng/mL, PTH 27 pg/mL, ALP 18 IU/L, bALP \2 mg/L, osteocalcin 43 ng/mL, and serum CTX 560 pg/mL. Spinal bone mineral density (BMD) was 1.05 g/cm (T score –1.1) and whole-body BMD 0.945 g/cm before treatment (femoral neck BMD could not be measured because of osteosynthesis), while spinal BMD was 1.04 and whole-body BMD was 0.920 after treatment. In the cases reported in the literature, teriparatide led to increased bALP levels and fracture healing [1–3]. However, although bone remodeling was stimulated in our patient, as shown by increased osteocalcin and CTX, teriparatide did not modify bALP levels or BMD and did not improve fracture healing. It caused marked bone pain and moderately elevated serum calcium. This is probably related to a different mechanism of decreased ALP activity, depending on the type of mutation: decrease in the quantity of the enzyme, its stability, or its catalytic power. In our patient, the N461L mutation led to complete disappearance of the bone isoenzyme, which was not modified by PTH treatment, whereas the level has been reported to increase in patients presenting the D378V [1] and the G339R, E191K, A176T, and V423A [2] mutations. The solution of the future could be treatment with recombinant ALP [3].