New research shows that a surgical procedure using a cutting-edge super glue pioneered a year ago by Calgary researchers can improve the recovery of heart patients recovering from open-chest surgery, Dr. Paul Fedak today told the Canadian Cardiovascular Congress 2010, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
The glue, called Kryptonite™, is being used to enhance the closure of the breastbone after surgery. "It has properties like natural bone and allows for new bone growth" says Dr. Fedak, a cardiac surgeon at Foothills Hospital Medical Centre. Up to this point, the breastbone has been closed only with steel wire that stays in the chest.
"One of the most common complaints among patients is sternal pain following heart surgery," he says "With this alternative procedure, significant healing occurs in hours rather than in weeks." By accelerating and improving bone stability, it allows patients to breathe deeply and painlessly without powerful painkillers, meaning fewer side effects. Enhanced bone stability results in fewer complications such as wound infections and bone separation.
Importantly, there were no associated side effects or complications after one year of follow-up.
With the new procedure, pain is cut down because the Kryptonite™ bonds so quickly and effectively to the breastbone. The breastbone becomes solid within hours, shortening the current recovery time of eight weeks by 50 per cent. "People get back to their regular activities much faster."
This much-anticipated release of the official study results prove that the Kryptonite™ adhesive is capable of enhancing the stability of the breastbone closure resulting in early benefits on post-operative recovery. Researchers found that benefits of the Kryptonite™ adhesive include:
Increased mechanical strength of the breastbone closure by five to 10 times that of wires alone.
Patients showing significantly less pain, a reduced need for painkillers, and improved breathing for weeks after the surgery.
Accelerated post-operative recovery time by weeks.
Patients have improved physical function and an improved health-related quality of life.
First reported on a year ago, when the procedure had been pilot tested on 20 patients, it has now been used on over 500 patients in hospitals across Canada and the United States. Based on the promising findings from the Calgary studies, a larger clinical trial has been established that will include 15 Canadian hospitals and three from the United States.
"It is estimated that 29,000 surgeries requiring sternotomy are performed annually in Canada. World-wide, 1.4 million are performed each year," says Heart and Stroke Foundation spokesperson Dr. Beth Abramson. "This procedure will potentially revolutionize surgical recovery around the world. It increases function, considerably improves quality of life, and ultimately saves the medical system money."
Improving a patient's function is important because walking in addition to medication is needed to keep patients healthy after surgery.
Physicians can be taught very easily to use Kryptonite™. The procedure does not require special equipment and takes only five minutes to perform.
Dr. Fedak has trained surgeons across Canada who now routinely perform the procedure on their patients.
Source:
Jane-Diane Fraser
Heart and Stroke Foundation of Canada
вторник, 28 июня 2011 г.
суббота, 25 июня 2011 г.
Denosumab Osteoporosis Study Meets Primary And All Secondary Bone Mineral Density Endpoints In Alendronate (FOSAMAX(R)) Transition Study
Amgen (NASDAQ: AMGN) announced findings from a head-to-head, double blind trial comparing the effects of denosumab in post-menopausal women with low bone mass transitioned from weekly alendronate (FOSAMAX(R)) versus continued alendronate therapy on bone mineral density (BMD). The study demonstrated superior results for the primary and all secondary endpoints.
In this one-year, non-pivotal Phase 3 study, the group treated with twice-yearly subcutaneous injections of denosumab achieved significantly greater BMD gains at all sites measured including the total hip (primary endpoint), lumbar spine, femoral neck, distal radius, and hip trochanter compared with the group that continued on alendronate. For the primary endpoint, the relative magnitude of BMD improvement at the total hip was approximately 80 percent greater in the denosumab versus the alendronate group.
The incidence and types of adverse events observed in this study, including neoplasm and infection, were well-balanced between the denosumab and alendronate treatment groups. The most common adverse events across both treatment arms were back pain, arthralgia, and nasal pharyngitis.
"This is the second Phase 3 head-to-head study demonstrating that administration of denosumab resulted in superior BMD gains versus those achieved with alendronate," said Roger M. Perlmutter, M.D., Ph.D., executive vice president of Research and Development at Amgen. "Particularly important was the finding that in this population that had previously been treated with alendronate, patients transitioned to denosumab achieved greater BMD gains than those continuing on alendronate therapy."
Study Design
This was a randomized, double-blind, active controlled, parallel group study. Eligible patients had T-scores of less than or equal to -2.0 and greater than or equal to -4.0 at the lumbar spine or total hip and had previously been treated with alendronate. A total of 504 women with low BMD participated in the study, with approximately 250 patients in each arm.
The study's primary endpoint was to evaluate the effect of denosumab treatment (twice yearly 60 mg) on total hip BMD in women with low bone mass compared to that in patients continuing alendronate therapy (weekly 70 mg) at 12 months. The secondary endpoints included evaluation of the effects of transitioning to denosumab compared to continuing treatment with alendronate on percent change from baseline in BMD at the lumbar spine, hip trochanter, femoral neck, and distal radius.
About Denosumab
Denosumab is the first fully human monoclonal antibody in late stage clinical development that specifically targets RANK Ligand, an essential regulator of osteoclasts (the cells that break down bone). Denosumab is being investigated for its potential to inhibit all stages of osteoclast activity through a targeted mechanism. Denosumab is being studied in a range of bone loss conditions including post-menopausal osteoporosis, rheumatoid arthritis, and cancer treatment-induced bone loss (in breast cancer and prostate cancer patients), as well as for its potential to delay bone metastases and inhibit and treat bone destruction across many stages of cancer.
Osteoporosis: Impact and Prevalence
Often referred to as the "silent epidemic," osteoporosis is a global problem that is increasing in significance as the population of the world both increases and ages. The World Health Organization (WHO) has recently identified osteoporosis as a priority health issue along with other major non-communicable diseases.
Although fractures to the vertebrae and hip are the most commonly discussed osteoporotic fractures, they do not account for the majority of fractures. In fact, fractures at skeletal sites such as the wrist, pelvis, humerus, clavicle, femur, and lower leg (tibia/fibula) make up an estimated 59 percent of all osteoporotic fractures in the United States (U.S.)(i).
The economic burden of osteoporosis is comparable to that of other major chronic diseases; for example, in the U.S. the costs associated with osteoporosis-related fractures are equivalent to those of cardiovascular disease and asthma(ii)(iii)(iv). It has been reported that osteoporosis results in more hospital bed-days than stroke, myocardial infarction or breast cancer(v).
About Amgen
Amgen discovers, develops, manufactures and delivers innovative human therapeutics. A biotechnology pioneer since 1980, Amgen was one of the first companies to realize the new science's promise by bringing safe and effective medicines from lab, to manufacturing plant, to patient. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cancer, kidney disease, rheumatoid arthritis, and other serious illnesses. With a deep and broad pipeline of potential new medicines, Amgen remains committed to advancing science to dramatically improve people's lives. To learn more about our pioneering science and our vital medicines, visit amgen.
Forward Looking Statements
This news release contains forward-looking statements that are based on management's current expectations and beliefs and are subject to a number of risks, uncertainties and assumptions that could cause actual results to differ materially from those described. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements, including estimates of revenues, operating margins, capital expenditures, cash, other financial metrics, expected legal, arbitration, political, regulatory or clinical results or practices, customer and prescriber patterns or practices, reimbursement activities and outcomes and other such estimates and results. Forward-looking statements involve significant risks and uncertainties, including those discussed below and more fully described in the Securities and Exchange Commission (SEC) reports filed by Amgen, including Amgen's most recent annual report on Form 10-K and most recent periodic reports on Form 10-Q and Form 8-K. Please refer to Amgen's most recent Forms 10-K, 10-Q and 8-K for additional information on the uncertainties and risk factors related to our business. Unless otherwise noted, Amgen is providing this information as of May 19, 2008 and expressly disclaims any duty to update information contained in this news release.
No forward-looking statement can be guaranteed and actual results may differ materially from those we project. Discovery or identification of new product candidates or development of new indications for existing products cannot be guaranteed and movement from concept to product is uncertain; consequently, there can be no guarantee that any particular product candidate or development of a new indication for an existing product will be successful and become a commercial product. Further, preclinical results do not guarantee safe and effective performance of product candidates in humans. The complexity of the human body cannot be perfectly, or sometimes, even adequately modeled by computer or cell culture systems or animal models. The length of time that it takes for us to complete clinical trials and obtain regulatory approval for product marketing has in the past varied and we expect similar variability in the future.
We develop product candidates internally and through licensing collaborations, partnerships and joint ventures. Product candidates that are derived from relationships may be subject to disputes between the parties or may prove to be not as effective or as safe as we may have believed at the time of entering into such relationship. Also, we or others could identify safety, side effects or manufacturing problems with our products after they are on the market. Our business may be impacted by government investigations, litigation and products liability claims. We depend on third parties for a significant portion of our manufacturing capacity for the supply of certain of our current and future products and limits on supply may constrain sales of certain of our current products and product candidate development.
In addition, sales of our products are affected by the reimbursement policies imposed by third-party payors, including governments, private insurance plans and managed care providers and may be affected by regulatory, clinical and guideline developments and domestic and international trends toward managed care and health care cost containment as well as United States (U.S.) legislation affecting pharmaceutical pricing and reimbursement. Government and others' regulations and reimbursement policies may affect the development, usage and pricing of our products. In addition, we compete with other companies with respect to some of our marketed products as well as for the discovery and development of new products. We believe that some of our newer products, product candidates or new indications for existing products, may face competition when and as they are approved and marketed. Our products may compete against products that have lower prices, established reimbursement, superior performance, are easier to administer, or that are otherwise competitive with our products. In addition, while we routinely obtain patents for our products and technology, the protection offered by our patents and patent applications may be challenged, invalidated or circumvented by our competitors and there can be no guarantee of our ability to obtain or maintain patent protection for our products or product candidates. We cannot guarantee that we will be able to produce commercially successful products or maintain the commercial success of our existing products. Our stock price may be affected by actual or perceived market opportunity, competitive position, and success or failure of our products or product candidates. Further, the discovery of significant problems with a product similar to one of our products that implicate an entire class of products could have a material adverse effect on sales of the affected products and on our business and results of operations.
The scientific information discussed in this news release related to our product candidates is preliminary and investigative. Such product candidates are not approved by the U.S. Food and Drug Administration (FDA), and no conclusions can or should be drawn regarding the safety or effectiveness of the product candidates. Only the FDA can determine whether the product candidates are safe and effective for the use(s) being investigated. Further, the scientific information discussed in this news release relating to new indications for our products is preliminary and investigative and is not part of the labeling approved by the FDA for the products.
The products are not approved for the investigational use(s) discussed in this news release, and no conclusions can or should be drawn regarding the safety or effectiveness of the products for these uses. Only the FDA can determine whether the products are safe and effective for these uses. Healthcare professionals should refer to and rely upon the FDA-approved labeling for the products, and not the information discussed in this news release.
FOSAMAX is a registered trademark of Merck & Co., Inc
References
(i) Johnell O, Kanis JA. Osteoporosis Int. 2006; 17:1726-1733.
(ii) Burge R, et al. J Bone Miner Res. 2007; 22:465-475
(iii) "Osteoporosis Fast Facts." Washington (DC): National Osteoporosis Foundation. Accessed at nof/osteoporosis/stats.html.
(iv) "Economic Cost of Cardiovascular Diseases." Dallas (TX): American Heart Association. Accessed at americanheart/statistics/10econom.html.
(v) Lippuner K, et al. "Incidence and direct medical costs of hospitalisations due to osteoporotic fractures in switzerland." Osteoporosis International. 1997; 7:414-25.
In this one-year, non-pivotal Phase 3 study, the group treated with twice-yearly subcutaneous injections of denosumab achieved significantly greater BMD gains at all sites measured including the total hip (primary endpoint), lumbar spine, femoral neck, distal radius, and hip trochanter compared with the group that continued on alendronate. For the primary endpoint, the relative magnitude of BMD improvement at the total hip was approximately 80 percent greater in the denosumab versus the alendronate group.
The incidence and types of adverse events observed in this study, including neoplasm and infection, were well-balanced between the denosumab and alendronate treatment groups. The most common adverse events across both treatment arms were back pain, arthralgia, and nasal pharyngitis.
"This is the second Phase 3 head-to-head study demonstrating that administration of denosumab resulted in superior BMD gains versus those achieved with alendronate," said Roger M. Perlmutter, M.D., Ph.D., executive vice president of Research and Development at Amgen. "Particularly important was the finding that in this population that had previously been treated with alendronate, patients transitioned to denosumab achieved greater BMD gains than those continuing on alendronate therapy."
Study Design
This was a randomized, double-blind, active controlled, parallel group study. Eligible patients had T-scores of less than or equal to -2.0 and greater than or equal to -4.0 at the lumbar spine or total hip and had previously been treated with alendronate. A total of 504 women with low BMD participated in the study, with approximately 250 patients in each arm.
The study's primary endpoint was to evaluate the effect of denosumab treatment (twice yearly 60 mg) on total hip BMD in women with low bone mass compared to that in patients continuing alendronate therapy (weekly 70 mg) at 12 months. The secondary endpoints included evaluation of the effects of transitioning to denosumab compared to continuing treatment with alendronate on percent change from baseline in BMD at the lumbar spine, hip trochanter, femoral neck, and distal radius.
About Denosumab
Denosumab is the first fully human monoclonal antibody in late stage clinical development that specifically targets RANK Ligand, an essential regulator of osteoclasts (the cells that break down bone). Denosumab is being investigated for its potential to inhibit all stages of osteoclast activity through a targeted mechanism. Denosumab is being studied in a range of bone loss conditions including post-menopausal osteoporosis, rheumatoid arthritis, and cancer treatment-induced bone loss (in breast cancer and prostate cancer patients), as well as for its potential to delay bone metastases and inhibit and treat bone destruction across many stages of cancer.
Osteoporosis: Impact and Prevalence
Often referred to as the "silent epidemic," osteoporosis is a global problem that is increasing in significance as the population of the world both increases and ages. The World Health Organization (WHO) has recently identified osteoporosis as a priority health issue along with other major non-communicable diseases.
Although fractures to the vertebrae and hip are the most commonly discussed osteoporotic fractures, they do not account for the majority of fractures. In fact, fractures at skeletal sites such as the wrist, pelvis, humerus, clavicle, femur, and lower leg (tibia/fibula) make up an estimated 59 percent of all osteoporotic fractures in the United States (U.S.)(i).
The economic burden of osteoporosis is comparable to that of other major chronic diseases; for example, in the U.S. the costs associated with osteoporosis-related fractures are equivalent to those of cardiovascular disease and asthma(ii)(iii)(iv). It has been reported that osteoporosis results in more hospital bed-days than stroke, myocardial infarction or breast cancer(v).
About Amgen
Amgen discovers, develops, manufactures and delivers innovative human therapeutics. A biotechnology pioneer since 1980, Amgen was one of the first companies to realize the new science's promise by bringing safe and effective medicines from lab, to manufacturing plant, to patient. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cancer, kidney disease, rheumatoid arthritis, and other serious illnesses. With a deep and broad pipeline of potential new medicines, Amgen remains committed to advancing science to dramatically improve people's lives. To learn more about our pioneering science and our vital medicines, visit amgen.
Forward Looking Statements
This news release contains forward-looking statements that are based on management's current expectations and beliefs and are subject to a number of risks, uncertainties and assumptions that could cause actual results to differ materially from those described. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements, including estimates of revenues, operating margins, capital expenditures, cash, other financial metrics, expected legal, arbitration, political, regulatory or clinical results or practices, customer and prescriber patterns or practices, reimbursement activities and outcomes and other such estimates and results. Forward-looking statements involve significant risks and uncertainties, including those discussed below and more fully described in the Securities and Exchange Commission (SEC) reports filed by Amgen, including Amgen's most recent annual report on Form 10-K and most recent periodic reports on Form 10-Q and Form 8-K. Please refer to Amgen's most recent Forms 10-K, 10-Q and 8-K for additional information on the uncertainties and risk factors related to our business. Unless otherwise noted, Amgen is providing this information as of May 19, 2008 and expressly disclaims any duty to update information contained in this news release.
No forward-looking statement can be guaranteed and actual results may differ materially from those we project. Discovery or identification of new product candidates or development of new indications for existing products cannot be guaranteed and movement from concept to product is uncertain; consequently, there can be no guarantee that any particular product candidate or development of a new indication for an existing product will be successful and become a commercial product. Further, preclinical results do not guarantee safe and effective performance of product candidates in humans. The complexity of the human body cannot be perfectly, or sometimes, even adequately modeled by computer or cell culture systems or animal models. The length of time that it takes for us to complete clinical trials and obtain regulatory approval for product marketing has in the past varied and we expect similar variability in the future.
We develop product candidates internally and through licensing collaborations, partnerships and joint ventures. Product candidates that are derived from relationships may be subject to disputes between the parties or may prove to be not as effective or as safe as we may have believed at the time of entering into such relationship. Also, we or others could identify safety, side effects or manufacturing problems with our products after they are on the market. Our business may be impacted by government investigations, litigation and products liability claims. We depend on third parties for a significant portion of our manufacturing capacity for the supply of certain of our current and future products and limits on supply may constrain sales of certain of our current products and product candidate development.
In addition, sales of our products are affected by the reimbursement policies imposed by third-party payors, including governments, private insurance plans and managed care providers and may be affected by regulatory, clinical and guideline developments and domestic and international trends toward managed care and health care cost containment as well as United States (U.S.) legislation affecting pharmaceutical pricing and reimbursement. Government and others' regulations and reimbursement policies may affect the development, usage and pricing of our products. In addition, we compete with other companies with respect to some of our marketed products as well as for the discovery and development of new products. We believe that some of our newer products, product candidates or new indications for existing products, may face competition when and as they are approved and marketed. Our products may compete against products that have lower prices, established reimbursement, superior performance, are easier to administer, or that are otherwise competitive with our products. In addition, while we routinely obtain patents for our products and technology, the protection offered by our patents and patent applications may be challenged, invalidated or circumvented by our competitors and there can be no guarantee of our ability to obtain or maintain patent protection for our products or product candidates. We cannot guarantee that we will be able to produce commercially successful products or maintain the commercial success of our existing products. Our stock price may be affected by actual or perceived market opportunity, competitive position, and success or failure of our products or product candidates. Further, the discovery of significant problems with a product similar to one of our products that implicate an entire class of products could have a material adverse effect on sales of the affected products and on our business and results of operations.
The scientific information discussed in this news release related to our product candidates is preliminary and investigative. Such product candidates are not approved by the U.S. Food and Drug Administration (FDA), and no conclusions can or should be drawn regarding the safety or effectiveness of the product candidates. Only the FDA can determine whether the product candidates are safe and effective for the use(s) being investigated. Further, the scientific information discussed in this news release relating to new indications for our products is preliminary and investigative and is not part of the labeling approved by the FDA for the products.
The products are not approved for the investigational use(s) discussed in this news release, and no conclusions can or should be drawn regarding the safety or effectiveness of the products for these uses. Only the FDA can determine whether the products are safe and effective for these uses. Healthcare professionals should refer to and rely upon the FDA-approved labeling for the products, and not the information discussed in this news release.
FOSAMAX is a registered trademark of Merck & Co., Inc
References
(i) Johnell O, Kanis JA. Osteoporosis Int. 2006; 17:1726-1733.
(ii) Burge R, et al. J Bone Miner Res. 2007; 22:465-475
(iii) "Osteoporosis Fast Facts." Washington (DC): National Osteoporosis Foundation. Accessed at nof/osteoporosis/stats.html.
(iv) "Economic Cost of Cardiovascular Diseases." Dallas (TX): American Heart Association. Accessed at americanheart/statistics/10econom.html.
(v) Lippuner K, et al. "Incidence and direct medical costs of hospitalisations due to osteoporotic fractures in switzerland." Osteoporosis International. 1997; 7:414-25.
среда, 22 июня 2011 г.
Researchers Find Pathway That Drives Spread Of Pediatric Bone Cancer In Preclinical Studies
Researchers have identified an important signaling pathway that, when blocked, significantly decreases the spread of pediatric bone cancer.
In their study, researchers at The University of Texas MD Anderson Children's Cancer Hospital in Houston found that blocking the Notch pathway in mice decreased metastases in the lungs 15-fold. The results of a series of pre-clinical studies were reported Sunday in an oral presentation at the 42nd Congress of the International Society of Pediatric Oncology.
Their research showed that the Notch pathway and Hes1 gene play a key role in promoting the metastasis of osteosarcoma, the most common form of bone cancer in children.
Approximately 400 children and teens under the age of 20 are diagnosed with osteosarcoma annually, and the majority present with cancer that has already metastasized. The primary destination for the cancer to spread is to the lungs, which accounts for more than 35 percent of pediatric patients dying from osteosarcoma.
"Knowing the initial results from blocking Notch in mice, we are encouraged to keep investigating the entire metastasis process, so we can find additional therapies and targets to prevent cancer from spreading and growing," said Dennis Hughes, M.D., Ph.D., lead investigator and assistant professor at MD Anderson Children's Cancer Hospital.
In addition to Notch and Hes1's role in metastasis, Hughes believes that their expression can be correlated with a patient's prognosis. Hughes conducted a small retrospective study looking at patient samples, and 39 percent of patients with high expression levels of Hes1 survived 10 years versus the 60 percent survival rate for patients who had lower levels.
Ongoing research is studying the impact of various therapies, such as Gamma-secretase inhibitors and histone deacetylase (HDAC) inhibitors, that regulate the Notch pathway and have the potential to affect cancer cell survival. Hughes found that HDAC inhibitors actually increased the Notch pathway in osteosarcoma cells that had low Hes1 expression, which was an unfavorable response in that sample group. However, for cells that presented with high Hes1 expression, where Notch was already maximized, the HDAC inhibitors led to osteosarcoma cell death.
"By defining vital signaling pathways in bone sarcomas, we hope small molecule inhibitors can be applied, leading to longer survival and reducing morbidity and late effects from intensive chemotherapy," said Hughes.
"We also hope these new findings may apply to other solid tumors such as breast, prostate, colon and more, but we'll need additional research to determine whether or not that is the case," he added.
Primary funding for the studies was provided through the Physician-Scientist Program at MD Anderson along with additional support from the Jori Zemel Children's Bone Tumor Foundation, Hope Street Kids Foundation and Joan Alexander Fund. Other collaborators include Pingyu Zhang, Ph.D., Yanwen Yang, Daniela Katz, M.D., and Patrick Zweidler-McKay, M.D., Ph.D., from MD Anderson Cancer Center as well as Dafydd Thomas, M.D., Ph.D., from the University of Michigan Medical Center.
Source:
Sara Farris
University of Texas M. D. Anderson Cancer Center
In their study, researchers at The University of Texas MD Anderson Children's Cancer Hospital in Houston found that blocking the Notch pathway in mice decreased metastases in the lungs 15-fold. The results of a series of pre-clinical studies were reported Sunday in an oral presentation at the 42nd Congress of the International Society of Pediatric Oncology.
Their research showed that the Notch pathway and Hes1 gene play a key role in promoting the metastasis of osteosarcoma, the most common form of bone cancer in children.
Approximately 400 children and teens under the age of 20 are diagnosed with osteosarcoma annually, and the majority present with cancer that has already metastasized. The primary destination for the cancer to spread is to the lungs, which accounts for more than 35 percent of pediatric patients dying from osteosarcoma.
"Knowing the initial results from blocking Notch in mice, we are encouraged to keep investigating the entire metastasis process, so we can find additional therapies and targets to prevent cancer from spreading and growing," said Dennis Hughes, M.D., Ph.D., lead investigator and assistant professor at MD Anderson Children's Cancer Hospital.
In addition to Notch and Hes1's role in metastasis, Hughes believes that their expression can be correlated with a patient's prognosis. Hughes conducted a small retrospective study looking at patient samples, and 39 percent of patients with high expression levels of Hes1 survived 10 years versus the 60 percent survival rate for patients who had lower levels.
Ongoing research is studying the impact of various therapies, such as Gamma-secretase inhibitors and histone deacetylase (HDAC) inhibitors, that regulate the Notch pathway and have the potential to affect cancer cell survival. Hughes found that HDAC inhibitors actually increased the Notch pathway in osteosarcoma cells that had low Hes1 expression, which was an unfavorable response in that sample group. However, for cells that presented with high Hes1 expression, where Notch was already maximized, the HDAC inhibitors led to osteosarcoma cell death.
"By defining vital signaling pathways in bone sarcomas, we hope small molecule inhibitors can be applied, leading to longer survival and reducing morbidity and late effects from intensive chemotherapy," said Hughes.
"We also hope these new findings may apply to other solid tumors such as breast, prostate, colon and more, but we'll need additional research to determine whether or not that is the case," he added.
Primary funding for the studies was provided through the Physician-Scientist Program at MD Anderson along with additional support from the Jori Zemel Children's Bone Tumor Foundation, Hope Street Kids Foundation and Joan Alexander Fund. Other collaborators include Pingyu Zhang, Ph.D., Yanwen Yang, Daniela Katz, M.D., and Patrick Zweidler-McKay, M.D., Ph.D., from MD Anderson Cancer Center as well as Dafydd Thomas, M.D., Ph.D., from the University of Michigan Medical Center.
Source:
Sara Farris
University of Texas M. D. Anderson Cancer Center
воскресенье, 19 июня 2011 г.
Lighten Up! Heavy Backpacks A Weighty Load For Children To Bear Libraries
While that new backpack your son or daughter just got for the new school year might seem harmless, there is the potential for a lifetime of back and neck ailments if not loaded or worn correctly, according to Dr. Paula Kramer, chair of the Department of Occupational Therapy at University of the Sciences in Philadelphia.
"While children's bodies are resilient, even they can't take the day after day stress caused by a backpack that is too heavy or worn improperly," Kramer said. "Even if the backpacks are made lighter, if the weight is not distributed correctly, there can be the prospect of long-term problems."
According to the U.S. Consumer Product Safety Commission, more than 7,000 emergency room visits in 2001 were related to backpacks and book bags with approximately half of those injuries occurring in children 5 to 14 years old.
"Parents should remember when they help their children to pack their backpacks, the heaviest items should be placed closest to the child's body and as close to their center of gravity as possible," Kramer explained. "Otherwise, not only will the heavy backpacks cause strain on backs and necks, but it will also make the child unsafe because it throws off their center of gravity."
The American Occupational Therapy Association (AOTA) concurs with a 2002 study in Spine that loaded backpacks weigh no more than 15 percent of a student's body weight. For example, a student weighing 100 pounds should carry no more that 15 pounds.
While it might not be the fashionable thing to do, backpacks should be worn with both shoulder straps, preferably ones that are well-padded, and adjusted so that the straps fit snugly. If the backpack comes with a waist belt, that too should worn to help distribute the weight. Ideally, it's best to use backpacks with wheels when a heavy load is unavoidable.
"When you have heavy backpacks, it's actually better to use ones with wheels," Dr. Kramer said. "However, some schools ban them and children don't consider them cool. It's a real conscious trade off for schools. If you don't allow backpacks with wheels, then you have to find some way to lighten up the backpacks. You have to require less text books to be taken home at night."
AOTA is sponsoring a National School Backpack Awareness Day on Wednesday, Sept. 20, 2006. The day will educate children, parents, school administrators, teachers, and communities about the serious health effects on children from backpacks that are too heavy or worn improperly.
The program will entail a "weigh in" for children to make sure their backpacks weigh no more than 15 percent of their body weight. Information about the correct ways to select, load and wear backpacks will be distributed. For more information, visit aota.
University of the Sciences in Philadelphia is a private, coeducational institution founded in 1821 as Philadelphia College of Pharmacy, the first college of pharmacy in North America. Comprising four colleges across a broad range of majors, USP specializes in educating students for rewarding careers through its undergraduate, graduate and doctoral degree programs in the health and related sciences.
University of the Sciences in Philadelphia
600 S. 43rd St.
Philadelphia, PA 19104
United States
University of the Sciences in Philadelphia
"While children's bodies are resilient, even they can't take the day after day stress caused by a backpack that is too heavy or worn improperly," Kramer said. "Even if the backpacks are made lighter, if the weight is not distributed correctly, there can be the prospect of long-term problems."
According to the U.S. Consumer Product Safety Commission, more than 7,000 emergency room visits in 2001 were related to backpacks and book bags with approximately half of those injuries occurring in children 5 to 14 years old.
"Parents should remember when they help their children to pack their backpacks, the heaviest items should be placed closest to the child's body and as close to their center of gravity as possible," Kramer explained. "Otherwise, not only will the heavy backpacks cause strain on backs and necks, but it will also make the child unsafe because it throws off their center of gravity."
The American Occupational Therapy Association (AOTA) concurs with a 2002 study in Spine that loaded backpacks weigh no more than 15 percent of a student's body weight. For example, a student weighing 100 pounds should carry no more that 15 pounds.
While it might not be the fashionable thing to do, backpacks should be worn with both shoulder straps, preferably ones that are well-padded, and adjusted so that the straps fit snugly. If the backpack comes with a waist belt, that too should worn to help distribute the weight. Ideally, it's best to use backpacks with wheels when a heavy load is unavoidable.
"When you have heavy backpacks, it's actually better to use ones with wheels," Dr. Kramer said. "However, some schools ban them and children don't consider them cool. It's a real conscious trade off for schools. If you don't allow backpacks with wheels, then you have to find some way to lighten up the backpacks. You have to require less text books to be taken home at night."
AOTA is sponsoring a National School Backpack Awareness Day on Wednesday, Sept. 20, 2006. The day will educate children, parents, school administrators, teachers, and communities about the serious health effects on children from backpacks that are too heavy or worn improperly.
The program will entail a "weigh in" for children to make sure their backpacks weigh no more than 15 percent of their body weight. Information about the correct ways to select, load and wear backpacks will be distributed. For more information, visit aota.
University of the Sciences in Philadelphia is a private, coeducational institution founded in 1821 as Philadelphia College of Pharmacy, the first college of pharmacy in North America. Comprising four colleges across a broad range of majors, USP specializes in educating students for rewarding careers through its undergraduate, graduate and doctoral degree programs in the health and related sciences.
University of the Sciences in Philadelphia
600 S. 43rd St.
Philadelphia, PA 19104
United States
University of the Sciences in Philadelphia
четверг, 16 июня 2011 г.
Researchers From ULB (Institute For Medical Immunology) Developed A Mouse Model Of Vascularized Bone Tranplantation
More and more composite tissue grafts are worldwide performed. This kind of graft implies to take a sample of all necessary tissues and vascular and nervous elements for the reconstruction of a given area.
This includes elbow, arm, hand and face transplantations and requires surgical skill and a multidisciplinary approach. Because in these cases transplanted tissues are always coming from a genetically non-identical donor (allograft), they generate a rejection process mediated by the recipient immune system. Therefore, chronic immunosuppression is required to prevent rejection and graft loss, with some side effects that may limit the indication of transplantation based on logic of cost-benefit ratio. The ideal solution would be to get reliable protocols for inducing transplantation tolerance.
Very recently, funded by the Melina Nakos foundation and the First Elite program of the Walloon region, and in collaboration with Professor FrГ©dГ©ric Schuind from Erasme hospital, doctors Zanzhuo Li and Alain Le Moine, at the Institute for Medical Immunology UniversitГ© libre de Bruxelles (ULB), developed a mouse model of composite tissue allograft including a vascularised femur.
The results of their research are published in the American Journal of Transplantation, the official journal of the American Society of Transplantation (AST).
In this model, a short course of immunosuppression at the time of transplantation allowed to make recipients robustly tolerant to the transplant. Importantly, tolerance was donor-specific, since recipients were still able to reject a third party allograft (unrelated to the donor), meaning that recipient immune system ultimately recovered responsiveness. It was shown that donor-type haematopoietic stem cells derived from the transplanted bone repopulated the recipient immune system and induced tolerance by removing anti-donor cells. This did not require recipient aggressive preconditioning which is considered as a too risky treatment to be applied in the context of composite tissue allografts. Therefore, vascularized bone transplantation containing donor-derived bone marrow cells might become a valuable tool for inducing transplantation tolerance in composite tissue allografts but also in other transplantations.
This study demonstrates the feasibility of stem cells grafts through a vascularised bone and the tolerance that it induces in the recipient of a composite tissue allograft.
In terms of clinical applications, this could be an alternative method to the intravenous injection of stem cells which does not induce a stable chimerism in the recipient unless after a heavy conditioning of the patient.
Zhanzhuo L, Benghiat FS, Kubjak C, Noval Rivas M, Cobbold S, Waldmann H, Petein M, Schuind F, Goldman M, Le Moine A. CD8+ T cell depletion and rapamycin synergize with signal 1 and 2 blockade to induce robust limb allograft tolerance in mice. Am J Transplant 2008 ; 8 : 1-10.
LIBRE DE BRUXELLES, UNIVERSITÉ
Campus du Solbosch
Avenue Franklin D. Roosevelt 50
B-1050 Bruxelles
ulb.ac.be
This includes elbow, arm, hand and face transplantations and requires surgical skill and a multidisciplinary approach. Because in these cases transplanted tissues are always coming from a genetically non-identical donor (allograft), they generate a rejection process mediated by the recipient immune system. Therefore, chronic immunosuppression is required to prevent rejection and graft loss, with some side effects that may limit the indication of transplantation based on logic of cost-benefit ratio. The ideal solution would be to get reliable protocols for inducing transplantation tolerance.
Very recently, funded by the Melina Nakos foundation and the First Elite program of the Walloon region, and in collaboration with Professor FrГ©dГ©ric Schuind from Erasme hospital, doctors Zanzhuo Li and Alain Le Moine, at the Institute for Medical Immunology UniversitГ© libre de Bruxelles (ULB), developed a mouse model of composite tissue allograft including a vascularised femur.
The results of their research are published in the American Journal of Transplantation, the official journal of the American Society of Transplantation (AST).
In this model, a short course of immunosuppression at the time of transplantation allowed to make recipients robustly tolerant to the transplant. Importantly, tolerance was donor-specific, since recipients were still able to reject a third party allograft (unrelated to the donor), meaning that recipient immune system ultimately recovered responsiveness. It was shown that donor-type haematopoietic stem cells derived from the transplanted bone repopulated the recipient immune system and induced tolerance by removing anti-donor cells. This did not require recipient aggressive preconditioning which is considered as a too risky treatment to be applied in the context of composite tissue allografts. Therefore, vascularized bone transplantation containing donor-derived bone marrow cells might become a valuable tool for inducing transplantation tolerance in composite tissue allografts but also in other transplantations.
This study demonstrates the feasibility of stem cells grafts through a vascularised bone and the tolerance that it induces in the recipient of a composite tissue allograft.
In terms of clinical applications, this could be an alternative method to the intravenous injection of stem cells which does not induce a stable chimerism in the recipient unless after a heavy conditioning of the patient.
Zhanzhuo L, Benghiat FS, Kubjak C, Noval Rivas M, Cobbold S, Waldmann H, Petein M, Schuind F, Goldman M, Le Moine A. CD8+ T cell depletion and rapamycin synergize with signal 1 and 2 blockade to induce robust limb allograft tolerance in mice. Am J Transplant 2008 ; 8 : 1-10.
LIBRE DE BRUXELLES, UNIVERSITÉ
Campus du Solbosch
Avenue Franklin D. Roosevelt 50
B-1050 Bruxelles
ulb.ac.be
понедельник, 13 июня 2011 г.
Millions With Arthritis May Benefit From Bone Loss Drug
People taking a widely used medication to strengthen fragile, aging bones may also be protecting their joints, according to a recent study led by Johns Hopkins rheumatologist Clifton Bingham, M.D.
Researchers began to wonder if risedronate might be used to treat osteoarthritis after noticing that the drug, and other compounds in the same class of drugs, not only slowed joint damage in animals, but also reduced cartilage-irritating bone lesions in humans.
For two years, an international team of investigators studied 2,483 arthritic men and women, from both the United States and Europe. All of those enrolled in the study had a loss in the cartilage that cushions the knee joint, a hallmark symptom of osteoarthritis.
Reporting in the most recent issue of the medical journal Arthritis & Rheumatism, Bingham and his team said study participants were given either a placebo or risedronate at a range of doses, including the standard doses normally prescribed to treat bone loss. The amount of cartilage detected in their knees was measured by X-ray analysis at the one- and two-year marks. Blood tests were also used to check for a marker of cartilage breakdown known as CTX-II.
CTX-II is released in the bloodstreams of people with osteoarthritis when cartilage begins to fray. How fast and to what degree cartilage breaks down can be approximated by levels of CTX-II.
"The blood tests revealed not only that risedronate stabilized bone loss, but also that it was most likely slowing the breakdown of cartilage, too" says Bingham.
Bingham emphasizes that X-rays failed to show any dramatic visible changes in the structure of the joints with risedronate compared to a placebo: however, the numbers of patients exhibiting significant progression of the disease were few in all treatment groups. A great challenge now is identifying the risk factors for joint deterioration in osteoarthritis, adds Bingham.
The investigators also did not see a significant reduction in joint pain with risedronate compared with the placebo.
In the United States, where an estimated 25 million people have osteoarthritis and 44 million have osteoporosis, participants in the study group taking risedronate experienced a noticeable drop in their CTX-II levels: 17.9 percent. The Europeans fared even better, with a 19.6 percent decrease. Patients taking the drug at normal levels and at higher than usual doses given for comparison experienced similar slowdowns in cartilage decline, without significant adverse side effects.
Those in the placebo group, however, experienced increases in CTX-II levels (26.3 percent for the Americans and 10.1 percent for the Europeans), suggesting that their cartilage was deteriorating faster than that in those taking the drug.
"We are not recommending that everyone with arthritis run out and get a prescription for these kinds of drugs, nor are we suggesting at this time that doctors use risedronate as an arthritis treatment," cautions Bingham. "But what we can say now is that drugs affecting bone turnover need to be further evaluated for their potential effects as arthritis therapies."
The blood test changes seen in the study would suggest that people already taking bone strengthening drugs may be simultaneously helping their joints, concludes Bingham.
Dr. Bingham has received consulting fees from Proctor & Gamble Pharmaceuticals, the makers of Actonel, the brand name for risedronate. Additionally, several other members of his research team have received consulting fees from other pharmaceutical companies.
Johns Hopkins Medical Institutions
901 S. Bond St., Ste 550
Baltimore, MD 21231
United States
hopkinsmedicine/
View drug information on Actonel.
Researchers began to wonder if risedronate might be used to treat osteoarthritis after noticing that the drug, and other compounds in the same class of drugs, not only slowed joint damage in animals, but also reduced cartilage-irritating bone lesions in humans.
For two years, an international team of investigators studied 2,483 arthritic men and women, from both the United States and Europe. All of those enrolled in the study had a loss in the cartilage that cushions the knee joint, a hallmark symptom of osteoarthritis.
Reporting in the most recent issue of the medical journal Arthritis & Rheumatism, Bingham and his team said study participants were given either a placebo or risedronate at a range of doses, including the standard doses normally prescribed to treat bone loss. The amount of cartilage detected in their knees was measured by X-ray analysis at the one- and two-year marks. Blood tests were also used to check for a marker of cartilage breakdown known as CTX-II.
CTX-II is released in the bloodstreams of people with osteoarthritis when cartilage begins to fray. How fast and to what degree cartilage breaks down can be approximated by levels of CTX-II.
"The blood tests revealed not only that risedronate stabilized bone loss, but also that it was most likely slowing the breakdown of cartilage, too" says Bingham.
Bingham emphasizes that X-rays failed to show any dramatic visible changes in the structure of the joints with risedronate compared to a placebo: however, the numbers of patients exhibiting significant progression of the disease were few in all treatment groups. A great challenge now is identifying the risk factors for joint deterioration in osteoarthritis, adds Bingham.
The investigators also did not see a significant reduction in joint pain with risedronate compared with the placebo.
In the United States, where an estimated 25 million people have osteoarthritis and 44 million have osteoporosis, participants in the study group taking risedronate experienced a noticeable drop in their CTX-II levels: 17.9 percent. The Europeans fared even better, with a 19.6 percent decrease. Patients taking the drug at normal levels and at higher than usual doses given for comparison experienced similar slowdowns in cartilage decline, without significant adverse side effects.
Those in the placebo group, however, experienced increases in CTX-II levels (26.3 percent for the Americans and 10.1 percent for the Europeans), suggesting that their cartilage was deteriorating faster than that in those taking the drug.
"We are not recommending that everyone with arthritis run out and get a prescription for these kinds of drugs, nor are we suggesting at this time that doctors use risedronate as an arthritis treatment," cautions Bingham. "But what we can say now is that drugs affecting bone turnover need to be further evaluated for their potential effects as arthritis therapies."
The blood test changes seen in the study would suggest that people already taking bone strengthening drugs may be simultaneously helping their joints, concludes Bingham.
Dr. Bingham has received consulting fees from Proctor & Gamble Pharmaceuticals, the makers of Actonel, the brand name for risedronate. Additionally, several other members of his research team have received consulting fees from other pharmaceutical companies.
Johns Hopkins Medical Institutions
901 S. Bond St., Ste 550
Baltimore, MD 21231
United States
hopkinsmedicine/
View drug information on Actonel.
пятница, 10 июня 2011 г.
Medtronic Receives Approval To Market Smaller Kit Sizes Of Infuse(R) Bone Graft
Medtronic, Inc. (NYSE: MDT) announced it has received approval to market two smaller kit sizes of INFUSE® Bone Graft for use in certain spinal fusion and dental regenerative procedures. The U.S. Food and Drug Administration (FDA) has approved two additional configurations of INFUSE Bone Graft: XX Small (0.7cc) kit and X Small (1.4cc) kit. These new sizes will be available for clinical use this June.
INFUSE® Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier. The purpose of the protein, which occurs naturally in the body, is to stimulate bone formation. It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures and also certain oral maxillofacial and dental regenerative bone grafting procedures. Implanted into a bone-deficient site, INFUSE® Bone Graft works with the body's own biology to induce normal bone formation. INFUSE® Bone Graft offers surgeons and their patients an alternative to autogenous bone grafting; eliminating the need to surgically harvest bone from other parts of the patient such as the shin, hip or chin.
"Since its initial market introduction, INFUSE® Bone Graft has enabled advances in surgical procedures and been used successfully in treating over 500,000 patients," said Doug King, Vice President Sales, Medtronic's Spinal and Biologics business. "Expanding the portfolio increases the availability to a broader number of patients and represents Medtronic's continued commitment to innovation in the science of bone regeneration and advancing surgical technology."
Patients and physicians can learn more about INFUSE® Bone Graft at infusebonegraft.
About the Spinal Business at Medtronic
Medtronic's spinal business, based in Memphis, Tenn., is the global leader in today's spine market and is committed to advancing the treatment of spinal conditions. Medtronic's spinal business collaborates with world-renowned surgeons, researchers and innovative partners to offer state-of-the-art products and technologies for neurological, orthopedic, oral maxillofacial and spinal conditions. Medtronic is committed to developing affordable, minimally invasive procedures that provide lifestyle friendly surgical therapies. More information about the company and its spinal treatments can be found at medtronicspinal and its patient-education Web sites, back, iscoliosis, maturespine and necksurgery.
About Medtronic
Medtronic, Inc., headquartered in Minneapolis, is the global leader in medical technology - alleviating pain, restoring health, and extending life for millions of people around the world.
INFUSE® Bone Graft has not been tested in pregnant women to determine if it could pose harm to a developing fetus, nor has it been studied in nursing mothers. Women of childbearing potential should not be treated with INFUSE Bone Graft immediately prior to or during pregnancy, and should be advised not to become pregnant for one year following treatment. They should be warned of potential risks and should discuss other possible treatments with their doctor. For important safety information, please go to here.
INFUSE®BONE GRAFT in combination with LT-CAGE®, INTER FIX™ or INTER FIX™ RP Implants incorporate technology developed by Gary K. Michelson, M.D.
Medtronic, Inc.
INFUSE® Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier. The purpose of the protein, which occurs naturally in the body, is to stimulate bone formation. It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures and also certain oral maxillofacial and dental regenerative bone grafting procedures. Implanted into a bone-deficient site, INFUSE® Bone Graft works with the body's own biology to induce normal bone formation. INFUSE® Bone Graft offers surgeons and their patients an alternative to autogenous bone grafting; eliminating the need to surgically harvest bone from other parts of the patient such as the shin, hip or chin.
"Since its initial market introduction, INFUSE® Bone Graft has enabled advances in surgical procedures and been used successfully in treating over 500,000 patients," said Doug King, Vice President Sales, Medtronic's Spinal and Biologics business. "Expanding the portfolio increases the availability to a broader number of patients and represents Medtronic's continued commitment to innovation in the science of bone regeneration and advancing surgical technology."
Patients and physicians can learn more about INFUSE® Bone Graft at infusebonegraft.
About the Spinal Business at Medtronic
Medtronic's spinal business, based in Memphis, Tenn., is the global leader in today's spine market and is committed to advancing the treatment of spinal conditions. Medtronic's spinal business collaborates with world-renowned surgeons, researchers and innovative partners to offer state-of-the-art products and technologies for neurological, orthopedic, oral maxillofacial and spinal conditions. Medtronic is committed to developing affordable, minimally invasive procedures that provide lifestyle friendly surgical therapies. More information about the company and its spinal treatments can be found at medtronicspinal and its patient-education Web sites, back, iscoliosis, maturespine and necksurgery.
About Medtronic
Medtronic, Inc., headquartered in Minneapolis, is the global leader in medical technology - alleviating pain, restoring health, and extending life for millions of people around the world.
INFUSE® Bone Graft has not been tested in pregnant women to determine if it could pose harm to a developing fetus, nor has it been studied in nursing mothers. Women of childbearing potential should not be treated with INFUSE Bone Graft immediately prior to or during pregnancy, and should be advised not to become pregnant for one year following treatment. They should be warned of potential risks and should discuss other possible treatments with their doctor. For important safety information, please go to here.
INFUSE®BONE GRAFT in combination with LT-CAGE®, INTER FIX™ or INTER FIX™ RP Implants incorporate technology developed by Gary K. Michelson, M.D.
Medtronic, Inc.
вторник, 7 июня 2011 г.
"Lighten The Load" Campaign - Tackling Musculoskeletal Disorders - Europe
Musculoskeletal disorders (MSDs) are the most common work-related health problem in Europe, affecting millions of workers. Across the EU27, 25% of workers complain of backache and 23% report muscular pains. Lighten the load, the European Agency for Safety and Health at Work's 2007 campaign to tackle MSDs in the workplace, supports an integrated management approach with three key elements. First, employers, employees and government need to work together to tackle MSDs. Secondly, any actions should address the 'whole load on the body', which covers all the stresses and strains being placed on the body, environmental factors such as cold working conditions, and the load being carried. Thirdly, employers need to manage the retention, rehabilitation and return to work of employees with MSDs.
What is the problem? Why MSDs?
Musculoskeletal disorders (MSDs) are the most common work-related health problem in Europe, affecting millions of European workers across all employment sectors, with the highest rates found in the agriculture and construction sectors.
Across the EU27, 25% of workers complain of backache and 23% report muscular pains. The situation is worse in the new Member States - almost 40% of workers report these two problems [1].
Impact of work on health (EU27 - all workers)[2]
The cost to individual companies, individual workers and their families, and to Europe and society at large, is high. MSDs not only result in high costs due to medical and social security expenses, and lost productivity, but also result in personal suffering for many workers.
Any worker can be affected, yet the problem can be prevented or reduced by following existing health and safety regulations, and is preventable by applying proper risk assessments, putting in place appropriate preventive measures based on guidance and good practice, and checking that these measures remain effective.
Lighten the load seeks to promote an integrated management approach to tackle MSDs embracing prevention of MSDs, and the retention, rehabilitation and reintegration of workers who already suffer from MSDs to make workplaces safer and healthier.
MSDs are the biggest cause of absence from work in practically all Member States. In some states, 40% of the costs of workers' compensation are caused by MSDs, and up to 1.6% of the gross domestic product (GDP) of the country itself. MSDs reduce company profitability and add to the social costs of government.[3]
Tackling MSDs is therefore a priority for the EU if we are to create more and better jobs in Europe. It is essential if European workers are to enjoy not only better quality jobs but a better quality of life and a higher standard of living.
What causes MSDs?
Lifting, carrying, pulling and pushing, making repetitive movements or working in the cold are all factors in the development of MSDs. Physical factors, though, are not the only causes. The way work is organised can also play a part. For example, workers with low levels of autonomy and job satisfaction are more likely to develop MSDs. A person's own medical history and physical capacity is also significant.
Physical, organisational and psychosocial, and individual factors may act separately, but the risk is greater if several risk factors work together.
Physical factors include: lifting, carrying, pulling and pushing; repetitive movements, working in the cold or in excessive heat; and awkward and static postures.
-- using force - lifting, carrying, pulling, pushing
-- repetition of movements - typing, painting
-- awkward and static posture - prolonged standing and sitting, working with hands above the shoulders
-- contact pressure - local compression of tools
-- vibration - whole body and hand-arm
-- cold working environments
Organisational and psychosocial factors include: performing tasks with low levels of autonomy; low job satisfaction; and repetitive, monotonous work, at a high pace.
-- high work demand
-- lack of control over work
-- low job satisfaction
-- repetitive work
-- high pace of work
-- time pressure
-- lack of support from colleagues and managers.
Individual factors include: medical history and physical capacity.
-- prior medical history
-- physical capacity
-- age
-- smoking
-- obesity.
MSDs affect more than just the back - although, of course, backache in itself can be very serious; muscles, joints, tendons, ligaments and nerves can all be affected.
MSDs can also be acute traumas, such as fractures, that occur during an accident. These mainly affect the back, neck, shoulders and upper limbs, but also concern lower limbs.
Disorders that affect the upper body are known as work-related neck and upper limb disorders (WRULDs). Symptoms may take a long time to develop and can manifest as pain, discomfort, numbness and tingling sensations. They are also known as 'repetitive strain injuries'; examples include carpal tunnel syndrome, tendonitis and vibration white finger.
Most work-related MSDs are cumulative disorders, resulting from repeated exposures to high or low intensity loads over a long period of time.
Who is affected?
Manual workers, whether skilled or unskilled, are most at risk from developing MSDs. As you might expect, older workers in Europe report more problems than younger employees.
Surprisingly perhaps, MSDs are not restricted to older male workers in manual jobs. It is estimated that nearly 4 million young workers in the EU under the age of 25 have backpain. [4] Physically demanding tasks such as working in awkward positions, handling heavy loads, prolonged standing and sitting, and repetitive work appear to be common among young workers which mean that they are at considerable risk of developing MSDs.
Agriculture and construction are the most affected sectors concerning exposure to physical risks and MSDs complaints. However, all sectors are concerned, but some employment groups are more at risk.
Particularly high rates are found among:
-- agricultural, forestry and fishing workers
-- construction workers
-- carpenters
-- drivers
-- nurses
-- cleaners
-- miners
-- machine operators
-- craft workers
-- tailors
-- retail workers
-- hotel, restaurant and catering workers
-- secretaries and typists
-- loaders and unloaders.
Women are less exposed to physical risk factors, although hand or arm movements and work involving painful or tiring positions are experienced equally by both.
For certain risks - jobs involving moving people - women are significantly more exposed than men. According to recent surveys, in the healthcare sector for example, an estimated 6-7 million women lift or move people and 3-4 million report backpain. In the retail sector, about 4 to 6 million women have to carry or move heavy loads, and about 10-11 million women are exposed to prolonged periods of standing or walking. (EU data [5])
MSDs are not restricted to older male workers in manual jobs. Physically demanding tasks such as working in awkward positions, handling heavy loads, prolonged standing and sitting, and repetitive work appear to be common among young workers which mean that they are at considerable risk of developing MSDs. It is estimated that nearly 4 million young workers in the EU under the age of 25 have backpain. (EU data [6])
Upper limb disorders - commonly known as repetitive strain injuries - affect women workers more than men, largely because of the type of work they do.
Workers in precarious employment, such as those on fixed-length contracts, are also significantly more exposed to repetitive work and working in painful or tiring positions.
Statistics
Is there any statistical evidence to justify the Lighten the load campaign?
There is a substantial - and growing - body of evidence. MSDs are the most common work-related health problem in Europe. Across the EU27, 25% of workers complain of backache and 23% report muscular pains. Both conditions are more prevalent in the new Member States, at 39% and 36% respectively.
Some 62% of workers are exposed a quarter of the time or more to repetitive hand and arm movements, 46% to painful or tiring positions and 35% to carrying or moving heavy loads. Agriculture and construction are the most affected sectors for both exposure to physical risks and musculoskeletal complaints, though MSDs occur in all sectors.
MSDs are the biggest cause of absence from work in practically all Member States. In some, 40% of the costs of workers' compensation are caused by MSDs, and up to 1.6% of the gross domestic product (GDP) of the country itself. They reduce company profitability and also add to the social costs of government. But these disorders also strongly reduce the employability and working capacity of those affected. Therefore, tackling MSDs is morally and ethically important.
Musculoskeletal disorders - a painful condition
Musculoskeletal disorders are the most common work-related health problems in the EU27: 25% of European workers complain of backache and 23% report muscular pains;
62% of workers in the EU-27 are exposed a quarter of the time or more to repetitive hand and arm movements; 46% to painful or tiring positions; 35% to carrying or moving heavy loads;
MSDs are costly conditions due to their direct - insurance, compensation, medical and administrative costs, and indirect costs of lost productivity.
Surely MSDS are only minor ailments?
The price of MSDs to workers, employers and governments is huge. For the employee, they cause personal suffering and loss of income; for the employer, they reduce business efficiency; and for government, they increase social security costs.
В· In the Czech Republic, MSDs account for one-third of all occupational diseases, and they are on the increase
В· An estimated 11.6 million working days a year are lost to work-related MSDs in the UK
Legislation
What are the legal provisions covering health and safety at work?
Council Directive 89/391 of 12 June 1989 introduced measures to encourage improvements in the safety and health of workers at work and puts general obligations on employers to assess risks, bring in protective measures, and provide information and training.
Are there specific Directives that address MSDs?
The main components of MSD prevention are recognised in European Directives, Member States' regulations and good practice guidelines. The Directives are supplemented by a series of European standards, known as EN standards, which fill out the details or enable the Directives to be implemented.
In addition to Directive 89/391, the main European Directives relevant to preventing MSDs are:
-- 89/654: minimum requirements for the workplace
-- 89/655: suitability of work equipment
-- 89/656: suitability of personal protective equipment
-- 90/269: identification and prevention of manual handling risks
-- 90/270: minimum health and safety requirements for work with display screen equipment
-- 93/104: organisation of working time
-- 98/37: machinery
-- 2002/44: identification and prevention of risks arising from vibration.
Are there any plans to introduce new legislation?
The Commission launched the first stage of consultation of the social partners on work-related MSDs on 9th November 2004. A second-stage consultation was launched earlier this year as the Commission considers that there is a need for further Community initiatives to improve the prevention of work-related MSDs.
Musculoskeletal disorders are currently covered by various Directives, however, only a limited number of work situations, i.e. the manual handling of loads, the work with display screen equipment and the activities involving exposure to local or whole-body vibration are covered by the current individual directives.
It is clear however that, apart from the specific area of exposure to vibration, the incidence of other ergonomic risk factors such as repetition, awkward/static postures, force or contact stress is not adequately addressed in the existing EU legislation.
For instance, awkward postures are not necessarily or exclusively linked to the manual handling of loads or the work with display screen equipment; they can also occur when performing tasks or work activities that involve repeatedly raising or working with the hands above the head, kneeling or squatting or just working with the back, neck or wrists bent. The same can be said for repetition as a risk factor occurring in performing tasks where the same motion or cycle of motions is repeated within a short time frame. Moreover, other risk factors such as contact stress - e.g. using the hand or knee as a hammer or working with objects that press hard into muscles or tendons - seem to be completely ignored by the current legislation.
The Commission, therefore, considers that a legislative initiative, setting out a revised, integrated and more legible EU regulatory framework on musculoskeletal disorders, might be appropriate.
[1] European Foundation for the Improvement of Living and Working Conditions, 4th European
Working Conditions Survey 2005, eurofound.europa.eu/ewco/surveys/EWCS2005/index.htm
[2] Fourth European Working Conditions Survey, European Foundation for the Improvement of Living and Working Conditions, 2007, available at eurofound.europa.eu/pubdocs/2006/98/en/2/ef0698en.pdf
[3] Reference for 1.6% figure loss by MSD:
Click here
The 4 % evidence is recorded e.g. in an ILO document:
Click here
(replace word "english" by "spanish" or "french" for other languages)
[4] Calculated from employment figures from the Eurostat LFS figures( Employment by sex, age groups and economic activity (1000), available at here.
[5] Calculated from Eurostat LFS employment statistics (Employment by sex, age groups and economic activity (1000))
[6] Calculated from Eurostat LFS employment statistics (Employment by sex, age groups and economic activity (1000))
europa.eu
What is the problem? Why MSDs?
Musculoskeletal disorders (MSDs) are the most common work-related health problem in Europe, affecting millions of European workers across all employment sectors, with the highest rates found in the agriculture and construction sectors.
Across the EU27, 25% of workers complain of backache and 23% report muscular pains. The situation is worse in the new Member States - almost 40% of workers report these two problems [1].
Impact of work on health (EU27 - all workers)[2]
The cost to individual companies, individual workers and their families, and to Europe and society at large, is high. MSDs not only result in high costs due to medical and social security expenses, and lost productivity, but also result in personal suffering for many workers.
Any worker can be affected, yet the problem can be prevented or reduced by following existing health and safety regulations, and is preventable by applying proper risk assessments, putting in place appropriate preventive measures based on guidance and good practice, and checking that these measures remain effective.
Lighten the load seeks to promote an integrated management approach to tackle MSDs embracing prevention of MSDs, and the retention, rehabilitation and reintegration of workers who already suffer from MSDs to make workplaces safer and healthier.
MSDs are the biggest cause of absence from work in practically all Member States. In some states, 40% of the costs of workers' compensation are caused by MSDs, and up to 1.6% of the gross domestic product (GDP) of the country itself. MSDs reduce company profitability and add to the social costs of government.[3]
Tackling MSDs is therefore a priority for the EU if we are to create more and better jobs in Europe. It is essential if European workers are to enjoy not only better quality jobs but a better quality of life and a higher standard of living.
What causes MSDs?
Lifting, carrying, pulling and pushing, making repetitive movements or working in the cold are all factors in the development of MSDs. Physical factors, though, are not the only causes. The way work is organised can also play a part. For example, workers with low levels of autonomy and job satisfaction are more likely to develop MSDs. A person's own medical history and physical capacity is also significant.
Physical, organisational and psychosocial, and individual factors may act separately, but the risk is greater if several risk factors work together.
Physical factors include: lifting, carrying, pulling and pushing; repetitive movements, working in the cold or in excessive heat; and awkward and static postures.
-- using force - lifting, carrying, pulling, pushing
-- repetition of movements - typing, painting
-- awkward and static posture - prolonged standing and sitting, working with hands above the shoulders
-- contact pressure - local compression of tools
-- vibration - whole body and hand-arm
-- cold working environments
Organisational and psychosocial factors include: performing tasks with low levels of autonomy; low job satisfaction; and repetitive, monotonous work, at a high pace.
-- high work demand
-- lack of control over work
-- low job satisfaction
-- repetitive work
-- high pace of work
-- time pressure
-- lack of support from colleagues and managers.
Individual factors include: medical history and physical capacity.
-- prior medical history
-- physical capacity
-- age
-- smoking
-- obesity.
MSDs affect more than just the back - although, of course, backache in itself can be very serious; muscles, joints, tendons, ligaments and nerves can all be affected.
MSDs can also be acute traumas, such as fractures, that occur during an accident. These mainly affect the back, neck, shoulders and upper limbs, but also concern lower limbs.
Disorders that affect the upper body are known as work-related neck and upper limb disorders (WRULDs). Symptoms may take a long time to develop and can manifest as pain, discomfort, numbness and tingling sensations. They are also known as 'repetitive strain injuries'; examples include carpal tunnel syndrome, tendonitis and vibration white finger.
Most work-related MSDs are cumulative disorders, resulting from repeated exposures to high or low intensity loads over a long period of time.
Who is affected?
Manual workers, whether skilled or unskilled, are most at risk from developing MSDs. As you might expect, older workers in Europe report more problems than younger employees.
Surprisingly perhaps, MSDs are not restricted to older male workers in manual jobs. It is estimated that nearly 4 million young workers in the EU under the age of 25 have backpain. [4] Physically demanding tasks such as working in awkward positions, handling heavy loads, prolonged standing and sitting, and repetitive work appear to be common among young workers which mean that they are at considerable risk of developing MSDs.
Agriculture and construction are the most affected sectors concerning exposure to physical risks and MSDs complaints. However, all sectors are concerned, but some employment groups are more at risk.
Particularly high rates are found among:
-- agricultural, forestry and fishing workers
-- construction workers
-- carpenters
-- drivers
-- nurses
-- cleaners
-- miners
-- machine operators
-- craft workers
-- tailors
-- retail workers
-- hotel, restaurant and catering workers
-- secretaries and typists
-- loaders and unloaders.
Women are less exposed to physical risk factors, although hand or arm movements and work involving painful or tiring positions are experienced equally by both.
For certain risks - jobs involving moving people - women are significantly more exposed than men. According to recent surveys, in the healthcare sector for example, an estimated 6-7 million women lift or move people and 3-4 million report backpain. In the retail sector, about 4 to 6 million women have to carry or move heavy loads, and about 10-11 million women are exposed to prolonged periods of standing or walking. (EU data [5])
MSDs are not restricted to older male workers in manual jobs. Physically demanding tasks such as working in awkward positions, handling heavy loads, prolonged standing and sitting, and repetitive work appear to be common among young workers which mean that they are at considerable risk of developing MSDs. It is estimated that nearly 4 million young workers in the EU under the age of 25 have backpain. (EU data [6])
Upper limb disorders - commonly known as repetitive strain injuries - affect women workers more than men, largely because of the type of work they do.
Workers in precarious employment, such as those on fixed-length contracts, are also significantly more exposed to repetitive work and working in painful or tiring positions.
Statistics
Is there any statistical evidence to justify the Lighten the load campaign?
There is a substantial - and growing - body of evidence. MSDs are the most common work-related health problem in Europe. Across the EU27, 25% of workers complain of backache and 23% report muscular pains. Both conditions are more prevalent in the new Member States, at 39% and 36% respectively.
Some 62% of workers are exposed a quarter of the time or more to repetitive hand and arm movements, 46% to painful or tiring positions and 35% to carrying or moving heavy loads. Agriculture and construction are the most affected sectors for both exposure to physical risks and musculoskeletal complaints, though MSDs occur in all sectors.
MSDs are the biggest cause of absence from work in practically all Member States. In some, 40% of the costs of workers' compensation are caused by MSDs, and up to 1.6% of the gross domestic product (GDP) of the country itself. They reduce company profitability and also add to the social costs of government. But these disorders also strongly reduce the employability and working capacity of those affected. Therefore, tackling MSDs is morally and ethically important.
Musculoskeletal disorders - a painful condition
Musculoskeletal disorders are the most common work-related health problems in the EU27: 25% of European workers complain of backache and 23% report muscular pains;
62% of workers in the EU-27 are exposed a quarter of the time or more to repetitive hand and arm movements; 46% to painful or tiring positions; 35% to carrying or moving heavy loads;
MSDs are costly conditions due to their direct - insurance, compensation, medical and administrative costs, and indirect costs of lost productivity.
Surely MSDS are only minor ailments?
The price of MSDs to workers, employers and governments is huge. For the employee, they cause personal suffering and loss of income; for the employer, they reduce business efficiency; and for government, they increase social security costs.
В· In the Czech Republic, MSDs account for one-third of all occupational diseases, and they are on the increase
В· An estimated 11.6 million working days a year are lost to work-related MSDs in the UK
Legislation
What are the legal provisions covering health and safety at work?
Council Directive 89/391 of 12 June 1989 introduced measures to encourage improvements in the safety and health of workers at work and puts general obligations on employers to assess risks, bring in protective measures, and provide information and training.
Are there specific Directives that address MSDs?
The main components of MSD prevention are recognised in European Directives, Member States' regulations and good practice guidelines. The Directives are supplemented by a series of European standards, known as EN standards, which fill out the details or enable the Directives to be implemented.
In addition to Directive 89/391, the main European Directives relevant to preventing MSDs are:
-- 89/654: minimum requirements for the workplace
-- 89/655: suitability of work equipment
-- 89/656: suitability of personal protective equipment
-- 90/269: identification and prevention of manual handling risks
-- 90/270: minimum health and safety requirements for work with display screen equipment
-- 93/104: organisation of working time
-- 98/37: machinery
-- 2002/44: identification and prevention of risks arising from vibration.
Are there any plans to introduce new legislation?
The Commission launched the first stage of consultation of the social partners on work-related MSDs on 9th November 2004. A second-stage consultation was launched earlier this year as the Commission considers that there is a need for further Community initiatives to improve the prevention of work-related MSDs.
Musculoskeletal disorders are currently covered by various Directives, however, only a limited number of work situations, i.e. the manual handling of loads, the work with display screen equipment and the activities involving exposure to local or whole-body vibration are covered by the current individual directives.
It is clear however that, apart from the specific area of exposure to vibration, the incidence of other ergonomic risk factors such as repetition, awkward/static postures, force or contact stress is not adequately addressed in the existing EU legislation.
For instance, awkward postures are not necessarily or exclusively linked to the manual handling of loads or the work with display screen equipment; they can also occur when performing tasks or work activities that involve repeatedly raising or working with the hands above the head, kneeling or squatting or just working with the back, neck or wrists bent. The same can be said for repetition as a risk factor occurring in performing tasks where the same motion or cycle of motions is repeated within a short time frame. Moreover, other risk factors such as contact stress - e.g. using the hand or knee as a hammer or working with objects that press hard into muscles or tendons - seem to be completely ignored by the current legislation.
The Commission, therefore, considers that a legislative initiative, setting out a revised, integrated and more legible EU regulatory framework on musculoskeletal disorders, might be appropriate.
[1] European Foundation for the Improvement of Living and Working Conditions, 4th European
Working Conditions Survey 2005, eurofound.europa.eu/ewco/surveys/EWCS2005/index.htm
[2] Fourth European Working Conditions Survey, European Foundation for the Improvement of Living and Working Conditions, 2007, available at eurofound.europa.eu/pubdocs/2006/98/en/2/ef0698en.pdf
[3] Reference for 1.6% figure loss by MSD:
Click here
The 4 % evidence is recorded e.g. in an ILO document:
Click here
(replace word "english" by "spanish" or "french" for other languages)
[4] Calculated from employment figures from the Eurostat LFS figures( Employment by sex, age groups and economic activity (1000), available at here.
[5] Calculated from Eurostat LFS employment statistics (Employment by sex, age groups and economic activity (1000))
[6] Calculated from Eurostat LFS employment statistics (Employment by sex, age groups and economic activity (1000))
europa.eu
суббота, 4 июня 2011 г.
Afferent Pharmaceuticals Presents Data Supporting Use Of P2X3 Antagonists In Reducing Bone Cancer Pain
Afferent Pharmaceuticals, a clinical-stage biopharmaceutical company developing first-in-class, small molecules that target P2X3 receptors, announced preclinical in vivo results demonstrating that an investigational P2X3 receptor antagonist significantly prevented and reversed bone cancer pain behavior in comparison to vehicle controls. These data expand on earlier findings and reveal that a marked reduction in apparent bone cancer pain occurs following oral administration of the proprietary P2X3 antagonist. Results from the study were presented in a poster session at the 13th World Congress on Pain in Montreal, Canada.
The study, co-authored by Anthony Ford, Ph.D., Founder and Chief Scientific Officer of Afferent Pharmaceuticals, was highlighted in a poster presentation titled, "P2X3 and P2X2/3 Antagonist as a Novel Bone Cancer Pain Treatment - In Vivo and In Vitro Mechanistic Insights." According to Dr. Ford, the study showed P2X3 antagonists reduced bone cancer pain behavior by dampening down dorsal horn neuronal activity, in addition to reducing activation of extracellular-signal regulated kinase (ERK) in dorsal root ganglion (DRG) neurons. The effects of the proprietary P2X3 antagonist on dorsal horn neuronal pathophysiology were investigated using in vivo electrophysiology measures, which allowed characterization of neuronal responses to mechanical, thermal and electrical stimuli. To study the intracellular pain sensing mechanisms in primary afferent neurons, a novel, in vitro co-culture system was created, combining MRMT-1 carcinoma cells and DRG neurons. ERK activation was decreased in the presence of the antagonist, AF-353.
"The results of this study capture some of the mechanistic elements that may support the use of P2X3 antagonists to treat bone cancer pain," commented Dr. Ford. "P2X3 receptors are preclinically well-validated targets, highly specific to unmyelinated, C fiber afferent nerves that have dense innervations in visceral organs, skin and joints. These small diameter fibers transmit sensations of pain and irritation via mechanisms that include ATP signaling. ATP released from cancer cells appears capable of driving peripheral sensitization, while P2X3 signaling in the dorsal horn is clearly adding central sensitization, and together these give rise to chronic cancer pain."
Dr. Ford added, "P2X3 receptors have limited distribution beyond sensory nerves and no significant expression in the higher centers of the brain. A highly specific and targeted approach to chronic pain therapy, including bone cancer pain, is expected to provide patients with a safer and more effective alternative to current treatments. Clinical treatments of bone cancer pain remain limited and often result in significant adverse side effects."
Authors of the poster were T. K. Kaan, P. K. Yip, S. Patel, M. Davies, F. Marchand, P. A. Nunn, A. H. Dickenson, A. P. Ford, Y. Zhong, M. Malcangio and S. B. McMahon.
Results from the study were simultaneously published in the September issue of Brain.
Source:
Afferent Pharmaceuticals
The study, co-authored by Anthony Ford, Ph.D., Founder and Chief Scientific Officer of Afferent Pharmaceuticals, was highlighted in a poster presentation titled, "P2X3 and P2X2/3 Antagonist as a Novel Bone Cancer Pain Treatment - In Vivo and In Vitro Mechanistic Insights." According to Dr. Ford, the study showed P2X3 antagonists reduced bone cancer pain behavior by dampening down dorsal horn neuronal activity, in addition to reducing activation of extracellular-signal regulated kinase (ERK) in dorsal root ganglion (DRG) neurons. The effects of the proprietary P2X3 antagonist on dorsal horn neuronal pathophysiology were investigated using in vivo electrophysiology measures, which allowed characterization of neuronal responses to mechanical, thermal and electrical stimuli. To study the intracellular pain sensing mechanisms in primary afferent neurons, a novel, in vitro co-culture system was created, combining MRMT-1 carcinoma cells and DRG neurons. ERK activation was decreased in the presence of the antagonist, AF-353.
"The results of this study capture some of the mechanistic elements that may support the use of P2X3 antagonists to treat bone cancer pain," commented Dr. Ford. "P2X3 receptors are preclinically well-validated targets, highly specific to unmyelinated, C fiber afferent nerves that have dense innervations in visceral organs, skin and joints. These small diameter fibers transmit sensations of pain and irritation via mechanisms that include ATP signaling. ATP released from cancer cells appears capable of driving peripheral sensitization, while P2X3 signaling in the dorsal horn is clearly adding central sensitization, and together these give rise to chronic cancer pain."
Dr. Ford added, "P2X3 receptors have limited distribution beyond sensory nerves and no significant expression in the higher centers of the brain. A highly specific and targeted approach to chronic pain therapy, including bone cancer pain, is expected to provide patients with a safer and more effective alternative to current treatments. Clinical treatments of bone cancer pain remain limited and often result in significant adverse side effects."
Authors of the poster were T. K. Kaan, P. K. Yip, S. Patel, M. Davies, F. Marchand, P. A. Nunn, A. H. Dickenson, A. P. Ford, Y. Zhong, M. Malcangio and S. B. McMahon.
Results from the study were simultaneously published in the September issue of Brain.
Source:
Afferent Pharmaceuticals
среда, 1 июня 2011 г.
Vigorous Exercise Strengthens Hip Bones In Young Children
Researchers from Southhampton and Cambridge Universities in the UK have presented evidence that vigorous physical activity in young children results in stronger hip bones. The results were presented at the World Congress on Osteoporosis (IOF WCO-ECCEO10) in Florence, Italy.
More than 200 six-year olds participated in the study. Using advanced scanning technology, the researchers measured bone mass and analysed the structure of the femoral neck (hip) and thigh bone. Physical activity was assessed for seven continuous days.
The results showed that there was a relationship between time spent in vigorous activity and strength of the femoral neck, both in terms of shape and volumetric mineral density. This was independent of other factors such as diet, lifestyle and physical size.
This supports the argument that increasing physical activity in childhood is likely to improve childhood skeletal bone development, and is thus a potentially important public health strategy towards prevention of osteoporosis in later life.
Source:
L. Misteli
International Osteoporosis Foundation
More than 200 six-year olds participated in the study. Using advanced scanning technology, the researchers measured bone mass and analysed the structure of the femoral neck (hip) and thigh bone. Physical activity was assessed for seven continuous days.
The results showed that there was a relationship between time spent in vigorous activity and strength of the femoral neck, both in terms of shape and volumetric mineral density. This was independent of other factors such as diet, lifestyle and physical size.
This supports the argument that increasing physical activity in childhood is likely to improve childhood skeletal bone development, and is thus a potentially important public health strategy towards prevention of osteoporosis in later life.
Source:
L. Misteli
International Osteoporosis Foundation
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