Early Occupation of the Caribou Lake Site,Colorado Front Range

Abstract

Chipping debris, a bifacial knife, and the stem of a probable Scottsbluff projectile point were found on the lower of two living surfaces at the Caribou Lake site, Grand County, Colorado. The age of associated charcoal was 8460 ± 140 radiocarbon years. It is uncertain whether the campsite, which lies at timberline near the base of an important pass across the continental divide, reflects seasonal utilization of high-altitude resources, or travel between the plains and mountain parks.     

The demography of Yellow Wagtails Motacilla flava on abandoned fields in northern European Russia

Capsule Apparent survival rates of Yellow Wagtails breeding in abandoned fields in Russia are determined by previous breeding success.

Aims To examine apparent survival and its link to previous breeding success in Yellow Wagtails breeding in abandoned fields in the Vologda region, northern European Russia.

Methods We ringed and measured apparent survival of Yellow Wagtails at two abandoned agricultural sites over eight years (2005–2012). We modelled the impact of age, nest stage, and time of season on daily nest survival rates.

Results Predation was the main cause of nest failure. Nest daily survival rate was highest at the beginning of the breeding season. Overall nest survival probability was 0.40?±?0.02. Adult apparent survival after successful breeding was 0.42?±?0.06 and after unsuccessful breeding this was 0.13?±?0.06.

Conclusion Reproductive success can be regarded as the crucial demographic parameter of the local Yellow Wagtail population in northern European Russia. Apparent survival after successful breeding is significantly higher than after unsuccessful breeding, because unsuccessful breeders probably move to new breeding sites the following year. High adult survival may be particularly important to Yellow Wagtail population dynamics in the study region, because second breeding attempts are apparently unusual.     

Hormone Replacement Therapy in Children with Hypogonadotropic Hypogonadism: Where do we Stand?

ObjectiveTo characterize hormone replacement therapy in a cohort of adolescent males and females with hypo-gonadotropic hypogonadism (HH) with a focus on changes in management during the past 10 years.MethodsMedical records of patients followed for HH during the past 10 years were reviewed.ResultsA total of 45 patients (22 female: 23 male) with HH were identified. The average age at HH diagnosis was 14.48 ± 2.02 years in females and 14.89 ± 1.64 years in males (P = .53). In females, the average age of pubertal induction was 14.53 ± 1.86 years. Conjugated equine estrogen was used in 54.5%, transdermal estradiol in 41%, and oral estradiol in 4.5%. The average duration to cycling was 1.96 ± 0.78 years. A progressive increase in the use of transdermal estradiol was noted over time, with 100% of females being started on this regimen since 2008. In males, the average age of induction was 15.22 ± 1.41 years. All were started on intramuscular testosterone cypionate at various doses. The average duration to full adult replacement was 1.95 ± 0.51 years.ConclusionThere is no current standard of care to guide pubertal induction in adolescents with HH. However, a significant increase in the use of transdermal estrogen was noted in females during the past 10 years. While much less variability in pubertal induction was seen in males, wide disparities in doses and escalation schedules were found. Prospective studies aimed at elucidating optimal strategies for sex steroid replacement in this pediatric population are badly needed. (Endocr Pract. 2013;19:968-971)     

颈前路“杂交式”与颈后路治疗多节段脊髓型颈椎病的临床比较

目的:比较颈前路"杂交式"减压融合与颈后路全椎板减压侧块内固定术治疗多节段脊髓型颈椎病的临床特点。方法:选择36例行"杂交式"颈前路治疗及33例行颈后路全椎板减压侧块内固定术治疗的多节段脊髓型颈椎病患者,观察两组患者手术前后一般资料、出血量、手术时间、颈椎生理曲度、JOA评分及并发症的发生情况。结果:两组患者术前的一般资料包括年龄(颈前路组:56.23±7.64岁,颈后路组:55.76±8.18岁)、性别(颈前路组:22男/14女,颈后路组:20男/13女)、颈椎生理曲度D值(颈前路组:7.41±3.14,颈后路组:8.19±2.74)、JOA评分(颈前路组:9.08±1.09分,颈后路组:8.82±1.26分)、病程(颈前路组:17.24±7.36月,颈后路组:15.75±5.78月)和受累节段(颈前路组:3.11±0.26个,颈后路组:3.24±0.39个)比较差异均无统计学意义(P0.05)。与颈后路相比,颈前路的术中出血量(颈前路组:221.79±178.02 mL,颈后路组:483.07±434.25 mL)更少,差异有统计学意义(P0.05),手术时间(颈前路组:196.54±51.88 min,颈后路组:175.12±54.93 min)更长,但差异无统计学意义(P0.05)。随着时间的延长,颈前路组患者颈椎生理曲度和JOA评分逐渐增大,而颈后路组患者椎生理曲度减少,JOA评分逐渐增大,差异有统计学意义(P0.05)。颈前路组出现植骨未融合、声音嘶哑和脑脊漏液,颈后路组发生轴性疼痛和C5神经根麻痹,但两组患者并发症的发生率比较差异无统计学意义(颈前路组:13.89%,颈后路组:12.12%)(P0.05)。结论:颈前路"杂交式"减压融合与颈后路全椎板减压侧块内固定术在治疗多节段脊髓型颈椎病上各有优点,临床根据患者的情况而采取合适的治疗方式。     

Patterns of Osteoporosis Medications Selection After Drug Holiday or Continued Therapy: A Real-World Experience

ObjectivePublished literature on physicians’ preferences and sequential treatment patterns of osteoporosis therapy is scarce.MethodsA retrospective cohort study of patients who received bisphosphonates, denosumab, and/or raloxifene for at least 3 consecutive years or teriparatide for at least 18 months for osteoporosis. Data collection spanned 10 years, from October 2007 to September 2016, at a tertiary care center in the United States.ResultsIn total, 12 885 patients were identified on the basis of receiving at least 1 treatment at any point in time; 1814 patients were randomly reviewed, and 274 patients met the inclusion criteria. The mean age was 68.8 ± 10.7 years, and women represented 90.9% of all the cases. Primary care physicians and rheumatologists constituted 65.7% and 22.6% of the prescribers, respectively. Before instituting a drug holiday, alendronate was the most common initial treatment (percentage, mean duration ± standard deviation in years: 69%, 5.4 ± 2.4 years) followed by ibandronate (9.5%, 4.9 ± 2.1 years) and raloxifene (9.1%, 5.2 ± 1.6 years). Denosumab was the most common second course of treatment, accounting for 29.3% of 82 patients who were subsequently prescribed another therapy, followed by alendronate (24.4%) and zoledronate (20.7%). Among patients who were placed on a drug holiday and eventually restarted on osteoporosis therapy, denosumab was the most common treatment instituted (n = 21), accounting for 40% of the total patients, followed by alendronate (32%) and zoledronate (16%). There was a progressive decline in osteoporosis therapy over the duration of the study.ConclusionAlendronate was the most common initial therapy. Denosumab was the most common second course of treatment prescribed.     

Long-Term Follow-up of patients on Drug Holiday from Bisphosphonates: Real-World Setting

ObjectiveAtypical femoral fractures and osteoporosis of the jaw have been associated with prolonged bisphosphonate therapy for postmenopausal osteoporosis. American Association of Clinical Endocrinologists guidelines suggest a drug holiday after 4 to 5 years of bisphosphonate treatment for moderate-risk patients and 10 years for high-risk patients, but there are minimal data on safe holiday durations. A recent U.S. Food and Drug Administration perspective suggests a treatment duration of 3 to 5 years. Our aim was to describe a group of patients on drug holiday and identify fracture risk.MethodsA retrospective chart review was conducted of 209 patients who started a bisphosphonate drug holiday between 2005 and 2010. Collected data included bone mineral density (BMD), markers of bone turnover, vitamin D status, and clinical and radiographic reports of fractures.ResultsEleven of 209 patients (5.2%) developed a fracture. Their mean age was 69.36 years (±15.58), and the mean lumbar spine and femoral neck T-scores were −2.225 (±1.779) and −2.137 (±0.950), respectively. All patients had a significant increase in bone-specific alkaline phosphatase at 6 months, which was more pronounced in the fracture group (3.0 ± 0.6083 μg/L vs. 1.16 ± 1.9267 μg/L). Over 4 years, there was no significant change in mean lumbar spine BMD for the entire cohort, but there was a statistically significant decline in the femoral neck BMD at year 2 (−0.0084 ± 0.03 gm/cm²).ConclusionThe current practice of initiating BP holidays needs further evaluation, particularly in the real-world setting. Elderly patients and those with very low BMD warrant close follow-up during a drug holiday. A fracture, early significant rise in bone turnover markers, and/or a decline in BMD should warrant resumption of osteoporosis therapy. (Endocr Pract. 2013;19:989-994)     

Safety of Vitamin D Replacement in Patients with Primary Hyperparathyroidism and Concomitant Vitamin D Deficiency

ObjectiveTo evaluate the safety of vitamin D replacement in patients with vitamin D deficiency and primary hyperparathyroidism.MethodsRetrospective chart review of 35 patients from our endocrine clinic, age 22 to 89 years, diagnosed with primary hyperparathyroidism and vitamin D deficiency, and treated with either 1,000 to 2,000 international units (IU) of vitamin D daily or 50,000 IU of vitamin D weekly for 5 months. Data were collected before and after treatment on serum calcium, 25-hydroxyvitamin D (25-OH D), intact parathyroid hormone (iPTH), phosphorus, alkaline phosphatase, nephrolithiasis, fractures, and osteoporosis.Results25-OH D increased significantly, from a baseline of 14.65 ± 6.57 ng/mL to 42.17 ± 12.98 ng/ mL after weekly treatment with 50,000 IU of vitamin D (P<.0001), and from 22.42 ± 5.47 ng/mL to 33.33 ± 6.39 ng/mL following daily treatment with 1,000 to 2,000 IU of vitamin D (P<.0001). Pre- and posttreatment unadjusted serum calcium remained stable in the high-dose group (10.80 ± 0.43 mg/dL vs. 10.72 ± 0.67 mg/dL; P = .47), but decreased slightly in the low-dose group (10.76 ± 0.58 mg/dL vs. 10.11 ± 0.54 mg/dL; P = .0007). After adjusting for age, sex, vitamin D, and PTH levels, the small calcium difference in the low-dose group became statistically insignificant. Treatment with either high or low doses of vitamin D did not significantly change iPTH levels. Creatinine remained stable in all patients, and no new cases of nephrolithiasis were reported.ConclusionReplacing vitamin D in mild primary hyperparathyroidism is safe, effective, and does not increase calcium to dangerous levels. (Endocr Pract. 2013;19:420-425)     

Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy

PurposeAccurate localization is crucial in delivering safe and effective stereotactic body radiation therapy (SBRT). The aim of this study was to analyse the accuracy of image-guidance using the cone-beam computed tomography (CBCT) of the VERO system in 57 patients treated for lung SBRT and to calculate the treatment margins.Materials and methodsThe internal target volume (ITV) was obtained by contouring the tumor on maximum and mean intensity projection CT images reconstructed from a respiration correlated 4D-CT. Translational and rotational tumor localization errors were identified by comparing the manual registration of the ITV to the motion-blurred tumor on the CBCT and they were corrected by means of the robotic couch and the ring rotation. A verification CBCT was acquired after correction in order to evaluate residual errors.ResultsThe mean 3D vector at initial set-up was 6.6 ± 2.3 mm, which was significantly reduced to 1.6 ± 0.8 mm after 6D automatic correction. 94% of the rotational errors were within 3°. The PTV margins used to compensate for residual tumor localization errors were 3.1, 3.5 and 3.3 mm in the LR, SI and AP directions, respectively.ConclusionsOn-line image guidance with the ITV–CBCT matching technique and automatic 6D correction of the VERO system allowed a very accurate tumor localization in lung SBRT.     

改良阶梯式截骨法矫正儿童创伤后肘内翻畸形

目的:探讨采用肱骨髁上改良阶梯式截骨联合钢板等内固定治疗儿童肘内翻畸形的临床疗效。方法:回顾性研究我科自2012年1月~2014年12月收治的14例肘内翻畸形患者,其中,男10例/女4例,年龄6~14岁,平均10.3岁,右侧9例/左侧5例。所有病例均有明确的伸直型肱骨髁上骨折病史,在创伤后约1.7年(1~4.5年)行改良阶梯式截骨。通过测量手术前后提携角及肘关节活动度,并依据Flynn临床肘关节功能评定标准对患肢功能进行评价。结果:本组患者术后均获得随访,随访时间12~26个月,平均17.4±2.7个月,肱骨截骨处达到骨性愈合的时间为2.5~4个月(平均2.9±0.6个月),术后畸形矫正良好,获得5.2±1.7°提携角。术后关节活动范围-0.7±1.6~134.5±2.4°,与术前相比,伸展活动的差异无统计学意义(t=0.871,P0.05);而屈曲活动改善明显,差异有统计学意义(t=18.819,P0.01)。末次随访时截骨纠正角度丢失1.4±0.8°。根据Flynn肘关节功能评定标准:优11例/良2例/可1例,优良率92.86%。均无感染、外髁突出、过度肥厚增生的术后瘢痕、血管神经损伤、关节不稳等并发症。结论:本研究针对创伤后儿童肘内翻畸形的手术疗效进行随访,发现改良阶梯式截骨的手术操作相对简单,矫形效果满意,能早期恢复肘关节功能且畸形复发率低,是一种美容效果较好的治疗肘内翻的截骨方式。     

Structural insight into the inhibition of acetylcholinesterase by 2,3,4, 5-tetrahydro-1, 5-benzothiazepines

Benzothiazepines 1–3 inhibited acetylcholinesterase (AChE; EC 3.1.1.7) enzyme in a concentration-dependent fashion with IC₅₀ values of 1.0 ± 0.002, 1.2 ± 0.005 and 1.3 ± 0.001 μM, respectively. By using linear-regression equations, Lineweaver-Burk, Dixon plots and their secondary replots were constructed which indicated that compounds 1–3 are non-competitive inhibitors of AChE with K_i values of 0.8 ± 0.04, 1.1 ± 0.002, and 1.5 ± 0.001 μM, respectively. Molecular docking studies revealed that all the compounds are completely buried inside the aromatic gorge of AChE, extending deep into the gorge of AChE. A comparison of the docking results of compounds 1–3 displayed that these compounds generally adopt the same binding mode in the active site of AChE. The superposition of the docked structures demonstrated that the non-flexible benzothiazepine always penetrate into the aromatic gorge through the six-membered ring A, which allowed the ligands to interact simultaneously with more than one subsites of the active center of AChE. The higher AChE inhibitory potential of compounds 1–3 was found to be the cumulative effect of hydrophobic contacts and π-π interactions between the ligands and AChE. The relatively high affinity of benzothiazepine 1 with AChE was found to be due to additional hydrogen bond in benzothiazepine 1-AChE complex. The results indicated that substitution of halogen and methyl groups by hydrogen at aromatic ring of the benzothiazepine decreased the affinity of these molecules towards enzyme that may be due to the polar non-polar repulsions of these moieties with the amino acid residues in the active site of AChE. The observed binding modes of benzothiazepines 1–3 in the active site of AChE explain the affinities of benzothiazepines and provide a rational basis for the structure-based drug design of benzothiazepines with improved pharmacological properties.     

Seasonal variation of circulating plasma carotenoids in Mediterranean Great Tit males Parus major

Capsule Mediterranean Great Tits showed a marked increase in levels of circulating carotenoids during moult and autumn.

Aims To study seasonal variation in plasma carotenoid content during a whole annual cycle for Great Tits Parus major inhabiting a Mediterranean woodland.

Methods We used a sample of 71 adult male Great Tits captured in NE Spain during a whole year. Data were organized into four seasons (winter, breeding, moult and autumn). We sampled blood to extract plasma. Carotenoid plasma concentrations were analysed by High-performance liquid chromatography (HPLC).

Results Lutein and zeaxanthin content varied seasonally, with a marked increase in levels during moult and autumn. Within the moulting period, levels increased gradually as the season progressed. This pattern differed significantly from that previously described in northern European populations, where high values appear mainly in the breeding season. Carotenoid concentrations (lutein: 1.2?±?0.25, zeaxanthin: 0.07?±?0.03?µg mL^?1) were also lower than in northern Europe.

Conclusion Mediterranean Great Tits show a very different pattern of circulating carotenoids and lower levels than northern European populations. The increasing pattern of carotenoid availability found within the moulting period raises the need to control for the effect of sampling date when analysing data on carotenoid concentrations at different times of year.     

Mercury in blood,hair, and feces from subsistence fish-eating riverines of the Madeira River Basin (Western Amazon)

BackgroundThe Madeira River (Amazon Basin) has been impacted by activities related to artisanal and small-scale gold mining (ASGM), deforestation and burning (for timber, agriculture, and hydroelectric dam projects). All these activities contribute to environmental mercury (Hg) release and cycling into the Amazon ecosystem and thus to changing lifestyles.MethodWe assessed exposure to total and MeHg in two small riverine communities of the Madeira River (Amazon): Lago Puruzinho (LP, n = 26 families) and São Sebastião do Tapurú (SST, n = 31 families). Samples of human hair (n = 137), blood (n = 39), and feces (n = 41) were collected from adults and children (0–15 years of age).ResultsIn women of childbearing age from LP village, the mean blood total-Hg (THg) (45.54 ± 24.76 μg.L⁻¹) and MeHg (10.79 ± 4.36 μg.L⁻¹) concentrations were significantly (p = 0.0024; p < 0.0001, respectively) higher than in women from SST village (THg: 25.32 ± 16.75 μg.L⁻¹; MeHg: 2.32 ± 1.56 μg.L⁻¹) village; the trend in hair-Hg persisted but was statistically significant (p < 0.0145) only for THg (LP, 11.34 ± 5.03 μg. g⁻¹; SST, 7.97 ± 3.51 μg. g⁻¹). In women, the median hair:blood ratio of total Hg was 269. In children, the mean hair THg concentrations were 6.07 ± 3.60 μg. g⁻¹ and 6.47 ± 4.16 μg. g⁻¹ in LP and SST; thus, not significantly different (p = 0.8006). There was a significant association (p < 0.001) between hair-Hg concentrations of mothers and their respective children. The excretion of Hg in feces of women (0.52 μg. g⁻¹ dw) was not significantly different from children (0.49 μg. g⁻¹ dw). The only statistically significant correlation between Hg in feces and in hair was found in children, (n = 16, r_s = 0.38, p = 0.005). Significant relationship was seen between the levels of THg in blood and hair of women from LP and SST. Based on hair-Hg concentrations, fish consumption rate ranged from 94.5 to 212.3 g.day⁻¹.ConclusionWomen and children excrete THg in feces in comparable concentrations. However, the mean fish consumption rate and blood MeHg are higher in the most remote villagers. Mother`s hair-Hg concentration is a good predictor of children’s hair-Hg.     

Reduced Parathyroid Hormone-Stimulated 1,25-Dihydroxyvitamin D Production in Vitamin D Sufficient Postmenoposual Women with Low Bone Mass and Idiopathic Secondary Hyperparathyroidism

ObjectiveDistinguishing secondary hyperparathyroidism (sHPT) from eucalcemic primary hyperparathyroidism (EC-pHPT) is important. The objective of this study was to measure parathyroid hormone (PTH)-stimulated production of 1α,25-dihydroxyvitamin D (1,25[OH]₂D) in early postmenopausal patients with idiopathic sHPT, who also fit the criteria for EC-pHPT, compared to age-matched controls.MethodsIn this pilot case-control study, postmenopausal women aged 44 to 55 years with normal serum calcium (Ca), glomerular filtration rate (GFR) ≥65 mL/min, and 25-hydroxyvitamin D (25[OH]D) ≥75 nmol/L (30 ng/mL) were given an 8 hour infusion of PTH(1-34), 12 pmol/kg/h. Patients (n = 5) had elevated PTH, normal 1,25(OH)₂D, and no hypercalciuria. Controls (n = 5) had normal PTH. At baseline, 4, and 8 hours, serum Ca, creatinine (Cr), phosphorus (P), 1,25(OH)₂D, fibroblast growth factor (FGF23), and 24,25(OH)₂D as well as urine Ca, P, Cr, and cAMP/GFR were measured. The fractional excretion of calcium (FeCa) and tubular reabsorption of phosphorus (TMP)/GFR were calculated.ResultsPatients had lower 1,25(OH)₂D levels (± SD) than controls at 4 (39.8 ± 6.9 versus 58.8 ± 6.7; P = .002) and 8 hours (56.4 ± 9.2 versus 105 ± 2.3; P = .003) of PTH infusion, attenuated after adjusting for higher body mass index (BMI) in patients (P = .05, .04), respectively. The 24,25(OH)2D levels were lower in patients than controls (1.9 ± 0.6 versus 3.4 ± 0.6, respectively; P = .007). No differences were seen in serum Ca or P, urine cAMP/GFR, TRP/GFR, FeCa, or PTH suppression at 8 hours (patients 50%, controls 64%).ConclusionVitamin D sufficient patients who fit the criteria for EC-pHPT had reduced PTH-stimulated 1,25(OH)₂D compared to controls, partially attributable to their higher BMI. Other causes of reduced 1,25(OH)₂D production ruled out were excessive catabolism of vitamin D metabolites, elevated FGF23, and CYP27B1 mutation. Elevated BMI and idiopathic reduced PTH-stimulated 1,25(OH)₂D production should be considered in the differential of sHPT. (Endocr Pract. 2013;19:91-99)     

Vitamin D Binding Protein Gene Polymorphism as a Risk Factor for Vitamin D Deficiency in Thais

ObjectiveVitamin D deficiency is related to increased risks for a number of diseases. To date, at least 3 candidate genes, vitamin D binding protein (VDBP) gene (GC), 25-hydroxylase (CYP2R1), and 7-dehydrocholes-terol reductase/NAD synthetase 1 (DHCR7/NADSYN1), have been associated with serum 25-hydroxyvitamin D (25[OH]D) levels, but their influences on the prevalence of vitamin D deficiency in relation to other known risk factors have not been clearly defined.MethodsThe study assessed 4,476 individuals aged 14 to 93 years from the Thailand 4^th National Health Examination Survey (2008-2009) and the Electricity Generating Authority of Thailand (EGAT) (2008) cohorts. The GC rs2282679 polymorphism on chromosome 4q12-q13 was genotyped by real-time polymerase chain reaction (PCR). Serum 25(OH)D was measured by liquid chromatography/tandem mass spectrometry. Vitamin D deficiency was defined as a 25(OH)D concentration < 20 ng/mL.ResultsData were expressed as mean ± SD. There were 2,747 (61.4%) males and 1,729 (38.6%) females in the study, with an average body mass index (BMI) of 23.7 ± 4.2 kg/m² and a mean total 25(OH)D of 28.9 ± 9.0 ng/mL. Serum 25(OH)D levels decreased progressively with the presence of the C allele. Using multiple logistic regression analysis, vitamin D deficiency was significantly associated with the GC rs2282679 genotype (odds ratio [OR] per C allele 1.80, 95% confidence interval CI 1.57-2.01), independent of established risk factors for vitamin D deficiency including age, sex, and BMI.ConclusionA specific GC gene polymorphism is associated with lower 25(OH)D levels independent of age, sex, and adiposity in Thai subjects. (Endocr Pract. 2015;21:221-225)     

Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

ObjectiveSecondary hyperparathyroidism commonly occurs in the setting of mid-to low-normal serum calcium levels, often in the setting of chronic kidney disease, phosphate loading, vitamin D deficiency, or insufficient calcium intake or absorption. In this article, we report 9 patients who had adequate kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m²) and normal 25-hydroxy vitamin D level (≥30 ng/dL) and whose secondary hyperparathyroidism resolved after starting adequate oral calcium intake.MethodsOur retrospective case series included 8 women and 1 man; the mean age was 69.0 ± 12.2 years (mean ± standard deviation). The initial intact parathyroid hormone (iPTH) level was 80.6 ± 13.4 pg/mL (reference range [ref], 10-65 pg/mL), corrected serum calcium level was 9.2 ± 0.2 mg/dL (ref, 8.5-10.5 mg/dL), serum phosphate level was 3.6 ± 0.4 mg/dL (ref, 2.5-4.9 mg/dL), 25-hydroxy vitamin D level was 42.2 ± 10.5 mg/dL (ref, 20-50 ng/mL), and estimated glomerular filtration rate was 72.6 ± 14.4 mL/min/1.73 m². Patients were treated clinically with oral calcium 600 mg twice a day.ResultsiPTH was retested after a mean duration of 17.6 ± 12.7 days of calcium supplementation; the iPTH level decreased to 51.0 ± 10.6 pg/mL, with all patients achieving iPTH in the normal range with normocalcemia, consistent with hyperparathyroidism being because of insufficient calcium intake or absorption. All patients were normocalcemic after supplementation.ConclusionSecondary hyperparathyroidism can result from insufficient oral calcium intake. Calcium challenge is an efficacious and cost-effective tool for confirming and treating secondary hyperparathyroidism in the setting of normal vitamin D levels and kidney function.     

Continuous Subcutaneous Pramlintide Infusion Therapy In Patients With Type 1 Diabetes: Observations From A Pilot Study

ObjectiveTo investigate the efficacy and safety of continuous (basal-bolus) subcutaneous pramlintide infusion (CSPI) in patients with type 1 diabetes mellitus.MethodsA 16-week, open-label, single-arm pilot study enrolled 11 patients (mean ± SD values: age, 39.9 ± 4.0 years; hemoglobin A1c, 8.20% ± 0.60%; weight, 92.3 ± 18.4 kg; body mass index, 29.7 ± 5.1 kg/m²) with longterm type 1 diabetes mellitus (20.7 ± 1.3 years; duration of pump therapy, 9.5 ± 6.0 years). Pramlintide basal infusion was begun with continuous subcutaneous infusion at 9 μg/h. After 3 days, premeal bolus doses of pramlintide were initiated at 15 μg and titrated to 60 μg per meal. Basal and bolus insulin doses were reduced 10% on initiation of CSPI and adjusted thereafter as needed to prevent hypoglycemia.ResultsAfter 16 weeks of pramlintide therapy, mean ± SD hemoglobin A1c decreased to 7.85% ± 0.74% (-0.35%). The fasting glucose level declined from 198.2 ± 66.9 mg/dL to 135.8 ± 63.9 mg/dL. The mean weight decreased to 91.8 ± 20.1 kg (-0.5 kg) at week 12. The daily bolus insulin requirement decreased 20%; daily basal insulin was unchanged (27.7 ± 11.7 U). All patients experienced mild postprandial hypoglycemia, but no severe hypoglycemia was reported. Three of the 11 study participants experienced mild initial nausea, but all patients successfully titrated bolus doses to 60 μg within 3 weeks.ConclusionIn this pilot study of 11 patients with type 1 diabetes using insulin pumps, CSPI seemed safe and well tolerated, did not alter pramlintide pharmacokinetic variables, and reduced fasting glucose levels. Larger studies of this method for pramlintide administration seem warranted. (Endocr Pract. 2009;15:689-695)     

超声刀联合双极电凝在开放甲状腺手术中的临床应用

目的:探讨超声刀联合双极电凝在开放式甲状腺手术中的临床应用价值。方法:选取我科2015年1月至2016年12月收治的224例甲状腺肿瘤患者,随机分为2组,A组112例患者采用超声刀和双极电凝进行手术,B组112例采用传统丝线结扎方法,2组均为开放式甲状腺手术。比较两组患者的手术时间、术中出血量、术后引流管拔出时间、住院时间以及术后并发症发生率。结果:A组手术时间、术中出血量、术后引流管拔出时间、住院时间分别为(58.7±10.5)min、(17.1±7.1)m L、(2.8±0.3)d、(8.8±0.5)d,均低于B组的(78.6±11.7)min、(41.5±8.2)m L、(3.9±0.3)d、(11.1±0.6)d,差异有统计学意义(P0.05);A组术后总并发症发生率为4.46%(5/112),低于B组的11.61%(13/112),差异有统计学意义(P0.05)。结论:在开放式甲状腺手术中使用超声刀联合双极电凝,可明显提高手术效果,降低术后并发症的发生率,从而提升甲状腺手术的安全性。     

Early Caddoan Subsistence Strategies,Sabine River Basin,East Texas

Abstract

Well preserved faunal and floral materials recovered from the Taddlock and Spoonbill sites in the Sabine River Basin of East Texas provide one of the first opportunities to document the subsistence strategies of sedentary hamlet occupations during the Early Caddoan period. The Taddlock site, dated ca. A.D. 940-1000, has a large faunal assemblage indicating a generalized and balanced exploitation of small and large mammals, reptiles, and fish. The two components at Spoonbill, dated ca. A.D. 970 ±65 and A.D. 1260±65, are characterized by an extensive floral sample of wild plant foods, seeds, and maize. At both sites, maize constitutes less than 10% by weight of the total plant food remains. The Early Caddoan inhabitants exploited a wide variety of animal and plant food, but at this time maize was likely one of several main sources of food energy rather than the focus of a specialized economy.     

Frailty assessment based on wavelet analysis during quiet standing balance test

BackgroundA standard phenotype of frailty was independently associated with an increased risk of adverse outcomes including comorbidity, disability and with increased risks of subsequent falls and fractures. Postural control deficit measurement during quiet standing has been often used to assess balance and fall risk in elderly frail population. Real time human motion tracking is an accurate, inexpensive and portable system to obtain kinematic and kinetic measurements. The aim of this study was to examine orientation and acceleration signals from a tri-axial inertial magnetic sensor during quiet standing balance tests using the wavelet transform in a frail, a prefail and a healthy population.MethodsFourteen subjects from a frail population (79±4 years), eighteen subjects from a prefrail population (80±3 years) and twenty four subjects from a healthy population (40±3 years) volunteered to participate in this study. All signals were analyzed using time–frequency information based on wavelet decomposition and principal component analysis.FindingsThe absolute sum of the coefficients of the wavelet details corresponding to the high frequencies component of orientation and acceleration signals were associated with frail syndrome.InterpretationThese parameters could be of great interest in clinical settings and improved rehabilitation therapies and in methods for identifying elderly population with frail syndrome.     

Vitamin D Insufficiency is Associated With Reduced Parasympathetic Nerve Fiber Function in Type 2 Diabetes

ObjectiveVitamin D insufficiency is prevalent in subjects with type 2 diabetes mellitus (T2DM) and is associated with peripheral neuropathy. However, there are little data regarding vitamin D status in patients with cardiovascular autonomic neuropathy. Our objective was to evaluate the association of cardiovascular autonomic function, 25-hydroxyvitamin D (25[OH]D) insufficiency (i.e., levels < 30 ng/mL), and multiple metabolic parameters in subjects with T2DM.MethodsWe examined 50 individuals with T2DM. Cardiovascular autonomic function (i.e., parasympathetic function) was assessed by RR-variation during deep breathing (i.e., mean circular resultant [MCR] and expiration/inspiration [E/I] ratio). Metabolic parameters included measures of adiposity, glycemic control, insulin resistance, calcium metabolism, and 25(OH)D.ResultsParticipants with 25(OH)D insufficiency (n = 26) were younger (66 ± 9 vs. 60 ± 10 years, P < .05), more insulin resistant, had a higher body mass index (BMI) and lower adiponectin levels. The MCR (39.5 ± 26.3 vs. 27.6 ± 17.2, P < .01) and E/I ratio (1.21 ± 0.17 vs. 1.15 ± 0.09, P < .01) were lower for those with 25(OH)D insufficiency after controlling for age. A stepwise selection procedure regressing MCR and E/I ratio on a number of metabolic parameters resulted in a model identifying age and 25(OH)D insufficiency as significant determinants for both measures. The interaction of age × 25(OH)D insufficiency was also included (MCR model, R² = 0.491, P < .001; E/I ratio, R² = 0.455, P < .001). Neither glycemic control nor other metabolic parameters were selected.ConclusionOur results suggest that 25(OH)D insufficiency is associated with reduced parasympathetic function, with a stronger association in younger persons with T2DM. Studies are needed to determine if vitamin D supplementation into the sufficient range could prevent or delay the onset of cardiovascular autonomic dysfunction. (Endocr Pract. 2015;21:174-181)