Osteoporosis is a bone disorder that reduces bone mineral density (BMD) and leads to bone fracture. In addition to different factors, gene polymorphisms have been revealed to be associated with osteoporosis. In this study, we investigated the association between the BsmI polymorphism of vitamin D receptor (VDR) gene (rs1544410) and BMD in a population of Iranian women.In this case control study, clinical risk factors for osteoporosis were obtained from the participants through a questionnaire for a case-control study. The World Health Organisation (WHO) criteria were applied for the diagnosis of the disease. Peripheral blood samples were obtained from 146 pre- and or postmenopausal Iranian women aged between 35 and 71 years (53.53 ± 9.8). The study population was classified for BMD into normal and osteoporotic groups, who matched for age, pregnancy status, menstrual condition, and body mass index (BMI). The BMD of the lumbar spine (L1-4) and femoral neck was measured. Polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) was performed to detect and analyze the genotype.The frequencies of AA and GG were significantly different between the two groups (p value<0.05), with the first genotype being higher in the patients and the second being higher in the normal group. The GG genotype was significantly associated with increased BMD in the lumbar spine (p value<0.05) but non-significant in the femoral neck (p value>0.05).BsmI polymorphism of VDR gene has a significant association with BMD in the lumbar spine and may have a minor effect on the proximal femur BMD in Iranian women.

Although it is well established that a higher body weight is protective against osteoporosis, the effects of body fat and fat distribution on bone mineral density (BMD) after adjustment for body weight remains uncertain.To examine the relationship between body fat and fat distribution and BMD beyond its weight-bearing effect in middle-aged Chinese adults.The study had a community-based cross-sectional design and involved 1,767 women and 698 men aged 50-75 years. The BMD of the lumbar spine, total hip, and whole body, and the fat mass (FM) and percentage fat mass (%FM) of the total body and segments of the body were measured by dual-energy X-ray absorptiometry. General information on the participants was collected using structured questionnaire interviews.After adjusting for potential confounders, an analysis of covariance showed the weight-adjusted (WA-) total FM (or %FM) to be negatively associated with BMD in all of the studied sites (P<0.05) in both women and men. The unfavorable effects of WA-total FM were generally more substantial in men than in women, and the whole body was the most sensitive site related to FM, followed by the total hip and the lumbar spine, in both genders. The mean BMD of the lumbar spine, total hip, and whole body was 3.93%, 3.01%, and 3.65% (in women) and 5.02%, 5.57%, 6.03% (in men) lower in the highest quartile (vs. lowest quartile) according to the WA-total FM (all p<0.05). Similar results were noted among the groups for WA-total FM%. In women, abdominal fat had the most unfavorable association with BMD, whereas in men it was limb fat.FM (or %FM) is inversely associated with BMD beyond its weight-bearing effect. Abdominal fat in women and limb fat in men seems to have the greatest effect on BMD.

SESSION TYPE: COPD: Severity and Risk PredictorsPRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE:

In the contest of a project designed to assess the influence of co-morbidities in the prognosis of COPD, we examined the prevalence of chronic heart failure (CHF), carotid and peripheral arterial disease, metabolic syndrome (MS), in elderly heavy smokers COPD patients.

METHODS:

We examined 60 outpatients with confirmed diagnosis of COPD (according to GOLD guidelines), aged ≥65 yrs, ≥20 pack/years, by measuring BODE index, Charlson Comorbidity Index(CCI) and COPD assessment test(CAT). All subjects underwent echocardiography and carotid ultrasonography. LV systolic dysfunction was defined as LV ejection fraction(LVEF) &lt;40%. Tricuspid Annular Plane Systolic Excursion(TAPSE) and pulmonary artery systolic pressure(PASP) were defined according to ASE guidelines(2010;23:685-713). Carotid intima-media thickness(IMT) and ankle-brachial blood pressure index(ABI) were measured using standard protocols. MS was defined according to AHA/NHLBI(2005;112:2735-52).

RESULTS:

Patients had mean age 71 yrs(range 65-81), mean pack/years 50. Thirteen patients were GOLD I, 26 II, 21 III. Mean BODE index was 1.6(range 0-8), CCI 2.1(range 1-7) and mean±SD CAT 14±7. Eighty-three% patients had one or more chronic co-morbidities, the commonest were hypertension(65%), ischemic heart disease(18%), depression(18%), diabetes(10%), osteoporosis(8%). MS was found in 42%. The number of comorbidities was not associated with age and COPD severity. Mean LVEF was 64% (range 34-80), and CHF was diagnosed in one patient. Mean±SD TAPSE was 19±3 mm, PAPS 15±15 mmHg. Focal carotid plaque was identified in 58% patients: 8% had history of carotid atherosclerosis, 17% history of aortic aneurysm, stroke, myocardial infarction, 33% did not. Interestingly, a positive significant association (p=0.005) was found between CCI and the presence of plaque. Mean±SD left IMT was 1.7±0.8 mm, right 1.7±0.7. Mean±SD ABI was 0.99±0.1; value &lt;0.9 was reported in 10% patients without history of peripheral arterial disease.

CONCLUSIONS:

These results confirm a very high prevalence of chronic co-morbidities associated to COPD, and subclinical carotid atherosclerosis in up to 50% of elderly heavy smokers COPD patients. Interestingly, the presence of carotid plaque was associated with the number of comorbidities.

CLINICAL IMPLICATIONS:

The high prevalence of subclinical atherosclerosis may explain the increased risk of cardiovascular morbidity and mortality in elderly COPD patients, who might then benefit of cardiovascular therapy. Funded by Ministero Salute and Chiesi Foundation.DISCLOSURE: The following authors have nothing to disclose: Alessia Verduri, Mihai Roca, Monica Bortolotti, Martina Garofalo, Sara Balduzzi, Jessica Veronesi, Chiara Leuzzi, Enrico Clini, Leonardo Fabbri, Bianca BeghéNo Product/Research Disclosure InformationRespiratory Department, University of Modena and Reggio Emilia, Modena, Italy.

SESSION TYPE: Thoracic Surgery Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE:

Evaluate the effectiveness of the new system of sternal stabilization named ZipFix® (Synthes) similar for the use of cable ties in poly-ether-ether-ketone (PEEK), biocompatible and radiolucent (no-scattering Rx standard, CT and MRI). The aim of this study is, therefore, consisted in bringing the benefits in terms of results in the short and long term duration/cost of the procedure and hospital stay, functional restoration even in patients at risk of dehiscence (osteoporosis, kidney failure, diabetes, COPD, hemorrhage, reoperation, mechanical ventilation, tracheotomy, radiation, obesity).

METHODS:

The cable ties are in large base of contact with the bone and equipped with needle plate and removable chamfer steel; were implanted through the intercostal space and in the parasternal in number of 3-5 from I to V space, according to the situation. Anatomically, the condition being treated or the preferences of the surgeon, with an mean duration of implant procedure about 16 minutes. Throughout the year 2011 the system was used with PEEK cable ties only for the synthesis of longitudinal median sternotomy in 6 patients.

RESULTS:

Short-term results: chest pain treated with 30 mg of ketorolac for three times a day to the removal of any drainage, absence of superficial and deep infections, bleeding (0% of cases), lack of early dehiscence and instability; mean duration of implant procedure 16 minutes. For long-term results: chest pain lag for the first 3 months and controlled effectively by administering paracetamol (500 mg in 80% of cases), absence of dehiscence, instability/deformation and chronic infections; excellent aesthetic results in 100% of cases, functional restoration and return to work after 40 days.

CONCLUSIONS:

Furthermore, this system can be combined with other methods of fixing sternal in relation to the choices of the surgeon and requires a rapid learning curve thanks to the considerable maneuverability and ease of installation.

CLINICAL IMPLICATIONS:

Due to the nature and mechanical performances of the polymeric material they are made of the cable ties ZipFix ® are definitely innovative and advantageous compared to other standard methods of sternal osteosynthesis.DISCLOSURE: The following authors have nothing to disclose: Cosimo Lequaglie, Gabriella Giudice, Rita daniela Marasco, Aniello Della MoretNo Product/Research Disclosure InformationIRCCS-CROB Centro di Riferimento Oncologico Basilicata, Rionero in Vulture PZ, Italy.

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE:

This particular complication of vertebroplasty calls for better awareness and care against such complication.

METHODS:

A 28-year male with 4-year history of ulcerative colitis was maintained on prednisolone, mesalazine and infiximab. He underwent cement vertebroplasty for severe lumbar spine osteoporosis, 24 hours after which he developed right pleuritic pain and dyspnea. Chest X-ray,Echocardiogram, Chest CT-Angiogram and Lab tests were performed.

RESULTS:

Lab tests: pO2 75mmHg & pCO2 25mmHg, pH 7.48, D-Dimer 5763 elevated (N ~500). Echocardiogram revealed pericardial effusion & echogenic mass in right atrium.Chest X-ray showed high density mass at the right atrium. CT-Angiogram showed high density masses in right atrium & pulmonary artery branches with a pericardial effusion Cardiac temponade necessitated ultrasound guided pericardial drainage and pulsating bloody fluid issued. Emergency cardiac surgery was performed. Cement masses were removed from both right atrium and right pulmonary branches. Tears in tricuspid valve and right atrial wall were repaired. The patient was discharged after one week and at 4-month follow up, he was still in excellent condition.

CONCLUSIONS:

Cement emboli following vertebroplasty has been reported in 6.8%. However, our case exemplifies dramatic event with right atrial and pulmonary artery involvement, which has not been previously described.

CLINICAL IMPLICATIONS:

We recommend use of large caliber needles to reduce injection pressure and more barium for better detection of extravasation.DISCLOSURE: The following authors have nothing to disclose: Samir Diab, Mohammad DiabNo Product/Research Disclosure InformationSpecialty Hospital, Amman, Jordan.

AIM:

We present a two stage reimplantation technique for infected total knee arthroplasty using a muscular gastrocnemious spacer that allows delivery of high local concentrations of antibiotics in absence of heterologous materials associated with high percentage of infection. MATERIAL OF STUDY: Between January 2009 and June 2011 we selected 8 patients with diagnosis of total knee arthroplasty deep infection. All patients underwent a surgical protocol that consisted of a two stage procedure with harvesting of medial gastrocnemious rotational flap followed by delayed reimplantation of prosthesis. All of them received 6 weeks of tailored intravenous antibiotics suggested by the infectious disease consultant and none had positive cultures at the time of reimplantation.

RESULTS:

The outcome was considered excellent for 6 of the 8 knees, good for 1, fair for 1, and poor for 0 joint. The reimplantion procedures were completely successful in all cases and all patients were able to walk again after rehabilitation program.

DISCUSSION:

Our surgical protocol guarantees wound healing without presence of disuse osteoporosis nor joint stiffness with scar tissue obliterating joint space. Moreover it shows a lower percentage of reinfection. This is connected to the presence of remaining microbiological organisms at the moment of closure that can develope a biofilm that adheres to biomaterial surfaces, enabling a complete bacterial eradication. The gastrocnemious muscle plays either the role of a natural spacer, either the function of coverage and protection of the new joint articulation after the reimplantation of the new device.

CONCLUSIONS:

The surgical and medical protocol used in our study resulted in clinical absence of infection in all our patients with lower postoperative complications in relation to the complete eradication of infection. KEY WORDS: Arthroplasty, Autologous Spacer, Gastrocnemious Muscular Flap.

Snyder-Robinson Syndrome (SRS, OMIM: 309583) is an X-linked intellectual disability syndrome, characterized by a collection of clinical features including facial asymmetry, marfanoid habitus, hypertonia, osteoporosis and unsteady gait. It is caused by a significant decrease or loss of spermine synthase (SMS) activity. Here we report a new missense mutation, p.Y328C, (c.1084A>G), in SMS in a family with X-linked intellectual disability. The affected males available for evaluation had mild ID, speech and global delay, an asthenic build, short stature with long fingers and mild kyphosis. The spermine/spermidine ratio in lymphoblasts was 0.53, significantly reduced compared to normal (1.87 average). Activity analysis of SMS in the index patient failed to detect any activity above background. In silico modeling demonstrated that the Y328C mutation has a significant effect on SMS stability, resulting in decreased folding free energy and larger structural fluctuations compared with those of wild type SMS. The loss of activity was attributed to the increase of conformational dynamics in the mutant which affects the active site geometry, rather than preventing dimer formation. Taken together, the biochemical and in silico studies confirm the p.Y328C mutation in SMS is responsible for the patients having a mild form of SRS and reveal yet another molecular mechanism resulting in a non-functional SMS causing SRS.