Spontaneous incomplete transverse subtrochanteric femoral fracture with cortical thickening possibly secondary to risedronate use: a case report

ABSTRACT: INTRODUCTION: Osteoporosis is an asymptomatic disease characterized by bone weakening and predisposition to fragility (insufficiency) fractures and can have devastating effects on individual life and great financial impact on the economy. Bisphosphonates are used worldwide for the primary and secondary prevention of osteoporotic fractures. However, increasing evidence raises concern that bisphosphonates can be associated with atypical fractures. CASE PRESENTATION: A 65-year-old Caucasian woman on long-term steroid treatment for polymyalgia rheumatica was admitted with severe and constant pain in the right hip, radiating to the right knee. She had a history of steroid-induced osteoporosis, for which she was started on risedronate four years earlier. She had no history of trauma. Her blood results were unremarkable. Her X-rays confirmed that she had an incomplete right subtrochanteric femoral fracture. A bone scan confirmed the diagnosis and also ruled out any other associated fractures. Our patient successfully underwent internal nail fixation of the fracture. She was reviewed by a rheumatology team, which stopped the risedronate. She was started on treatment with denosumab injection. CONCLUSIONS: Previous case series have reported that long-term bisphosphonate use is associated with atypical fractures of the femur, and certain criteria have been established to help identify such rare fractures. Delayed union or non-union is expected in such fractures following definitive orthopedic treatment because of the long half life of bisphosphonates. In this case report, we try to raise questions related to this important subject, like the duration and safety of bisphosphonate use and the alternative medications used in osteoporosis in this rare condition. We consider this case report not only interesting but also important and unusual because it is about a patient who developed a potentially rare and serious side effect of long-term bisphosphonate use, estimated to affect 2.3 in every 10,000 patients, and who presented with a pelvic X-ray that showed the characteristic features of atypical fractures secondary to risedronate use. In addition, most of the documented cases have been associated with many years of bisphosphonate use whereas our patient had been on risedronate for only four years.     

Arsenite and arsenate impact the oxidative status and antioxidant responses in Ocimum tenuiflorum L

Physiology and Molecular Biology of Plants - Biochemical responses of Ocimum tenuiflorum plants were studied upon exposure to arsenite (AsIII) and arsenate (AsV) for 1 to 10 d. Plants...     

Cerebellar Nuclear Neurons Use Time and Rate Coding to Transmit Purkinje Neuron Pauses

Neurons of the cerebellar nuclei convey the final output of the cerebellum to their targets in various parts of the brain. Within the cerebellum their direct upstream connections originate from inhibitory Purkinje neurons. Purkinje neurons have a complex firing pattern of regular spikes interrupted by intermittent pauses of variable length. How can the cerebellar nucleus process this complex input pattern? In this modeling study, we investigate different forms of Purkinje neuron simple spike pause synchrony and its influence on candidate coding strategies in the cerebellar nuclei. That is, we investigate how different alignments of synchronous pauses in synthetic Purkinje neuron spike trains affect either time-locking or rate-changes in the downstream nuclei. We find that Purkinje neuron synchrony is mainly represented by changes in the firing rate of cerebellar nuclei neurons. Pause beginning synchronization produced a unique effect on nuclei neuron firing, while the effect of pause ending and pause overlapping synchronization could not be distinguished from each other. Pause beginning synchronization produced better time-locking of nuclear neurons for short length pauses. We also characterize the effect of pause length and spike jitter on the nuclear neuron firing. Additionally, we find that the rate of rebound responses in nuclear neurons after a synchronous pause is controlled by the firing rate of Purkinje neurons preceding it.     

Inhibition of Tumor Necrosis Factor Alpha (TNFα) Expression and Function In Vitro by Modified Antisense Oligonucleotides

Abstract

Antisense oligonucleotides containing C-5 hexynyl/propynyl modified pyrimidines were synthesized using solid phase phosphoramidite chemistry. These modified oligonucleotides were found to have significant inhibitory activity against TNFα production in vitro.     

An epi(c)genetic war: Pathogens,cancer and human genome

Cancer is characterized by inter- and intra-tumor heterogeneity and this is also observed in the context of cancers caused by pathogens. Nearly 20% of all cancers are attributable to pathogenic organisms. Pathogenic infections result in deregulation of gene expression both by genetic and epigenetic mechanisms, thereby causing malignant transformation. Another characteristic of pathogen-induced cancers is the occurrence of chronic inflammation due to activation of the innate and adaptive arms of the immune system. This review focuses on the epigenetic changes induced by oncoviruses, parasites, cancer-causing bacteria and ‘endogenous pathogens’ to trigger host cell proliferation indefinitely as well as the inflammation associated with pathogen-induced cancers. The opportunity of targeting components of both pathogen and host epigenetic machinery to limit tumor progression is also discussed.     

Stochastical aspects of neuronal dynamics: Fokker-Planck approach

The Stochastical aspects of noise-perturbed neuronal dynamics are studied via the Fokker-Planck equation by considering the Langevin-type relaxational, nonlinear process associated with neuronal states. On the basis of a canonical, stochastically driven, dichotomous state modeling, the equilibrium conditions in the neuronal assembly are analyzed. The markovian structure of the random occurrence of action potentials due to the disturbances (noise) in the neuronal state is considered, and the corresponding solutions relevant to the colored noise spectrum of the disturbance effects are addressed. Stochastical instability (Lyapunov) considerations in solving discrete optimization problems via neural networks are discussed. The bounded estimate(s) of the Stochastical variates involved are presented, and the noise-induced perturbations on the saturated-state neuronal population are elucidated.     

Floral morphology of the family compositae

Vernonia anthelmintica (Linn.) Willd., tribe Vernonieae, family Compositae has been studied. The cypsela has dimorphic pappus, 20 longitudinal ribs (10 primary and 10 secondary), and two types of hairs developing from single epidermal cells on surface. Certain features of vasculature of floret observed in this taxon have been considered as intermediate between relatively primitive and highly advanced conditions known in the family. Others elucidate further that the ovary is bilocular with axile placentation at base in which region the ovule is attached, and unilocular with parietal placentation in the remaining portion, and also that the ovule possibly belongs to one of the two carpels, which alone is fertile, and is an organ morphologically double in nature. The pappus has been regarded as a longitudinally dismembered calyx tube. The tissue of the ovule outside nucellus differentiates into an endothelium, a periendothelial zone, and an outer zone. In the mature seed the thickned outer epidermis and remmants of a few subjacent layers form the outer zone, and endothelium redued to a pellicle, the inner zone of the seed coat. The jacket layer of the endosperm persists between the seed coat and the dicotyledonous, orthorrhizal embryo. The pericarp development resembles that of most other Compositae in an early differentiation of the ovary wall into two zones, and later breakdown of a major part of the inner zone. But it is quite characteristic in other respects, especially, the peripheral chin of firovascular bundles which forms its main mechanical zone.     

A spatial vascular transcriptomic,proteomic, and phosphoproteomic atlas unveils an angiocrine Tie–Wnt signaling axis in the liver

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