Creation of an Age-Adjusted, Dual-Energy X-ray Absorptiometry-Derived Trabecular Bone Score Curve for the Lumbar Spine in Non-Hispanic US White Women.

The trabecular bone score (TBS, Med-Imaps, Pessac, France) is an index of bone microarchitecture texture extracted from anteroposterior dual-energy X-ray absorptiometry images of the spine. Previous studies have documented the ability of TBS of the spine to differentiate between women with and without fractures among age- and areal bone mineral density (aBMD)-matched controls, as well as to predict future fractures. In this cross-sectional analysis of data collected from 3 geographically dispersed facilities in the United States, we investigated age-related changes in the microarchitecture of lumbar vertebrae as assessed by TBS in a cohort of non-Hispanic US white American women. All subjects were 30 yr of age and older and had an L1-L4aBMDZ-score within ±2 SD of the population mean. Individuals were excluded if they had fractures, were on any osteoporosis treatment, or had any illness that would be expected to impact bone metabolism. All data were extracted from Prodigy dual-energy X-ray absorptiometry devices (GE-Lunar, Madison, WI). Cross-calibrations between the 3 participating centers were performed for TBS and aBMD. aBMD and TBS were evaluated for spine L1-L4 but also for all other possible vertebral combinations. To validate the cohort, a comparison between the aBMD normative data of our cohort and US non-Hispanic white Lunar data provided by the manufacturer was performed. A database of 619 non-Hispanic US white women, ages 30-90 yr, was created. aBMD normative data obtained from this cohort were not statistically different from the non-Hispanic US white Lunar normative data provided by the manufacturer (p = 0.30). This outcome thereby indirectly validates our cohort. TBS values at L1-L4 were weakly inversely correlated with body mass index (r = -0.17) and weight (r = -0.16) and not correlated with height. TBS values for all lumbar vertebral combinations decreased significantly with age. There was a linear decrease of 16.0% (-2.47 T-score) in TBS at L1-L4 between 45 and 90 yr of age (vs. -2.34 for aBMD). Microarchitectural loss rate increased after age 65 by 50% (-0.004 to -0.006). Similar results were obtained for other combinations of lumbar vertebra. TBS, an index of bone microarchitectural texture, decreases with advancing age in non-Hispanic US white women. Little change in TBS is observed between ages 30 and 45. Thereafter, a progressive decrease is observed with advancing age. The changes we observed in these American women are similar to that previously reported for a French population of white women (r(2) > 0.99). This reference database will facilitate the use of TBS to assess bone microarchitectural deterioration in clinical practice.

Angioplastie des stenoses juxta-anastomotiques de survenue precoce apres creation de fistules d'hemodialyse

Objectifs: Evaluer l'angioplastie au ballon pour le traitement des sténoses juxta-anastomotiques de survenue précoce après création des fistules d'hémodialyse.Matériels et méthodes: De septembre 2004 à septembre 2005, 9 patients ont été référés dans notre institution pour traitement d'une sténose juxta-anastomotique (0-2 cm post-anastomotiques) diagnostiquée 1 (n = 2) à 3 mois (n = 7) après chirurgie. La sténose était détectée par défaut de développement de la fistule (n = 9), échec de ponction ou de dialyse (n = 7). L'échographie confirmait une réduction de diamètre de plus de 50 % (n = 9). Après approche rétrograde veineuse 6F, l'angioplastie était réalisée avec un ballon de 4 mm (n = 4) ou 5 mm (n = 5) et complétée par angioplastie au cutting ballon de 4 mm en cas de sténose résiduelle. Le succès technique était l'absence de sténose résiduelle < 30 %, le succès clinique la dialyse possible à 3 mois de suivi.Résultats: Le succès technique était obtenu chez 8 patients (1 cas de thrombose suivant l'angioplastie) et le succès clinique chez 6/8 patients. Chez les 2 patients restants, la fistule ne se développait pas malgré l'absence de sténose récidivante.Conclusion: L'angioplastie au ballon devrait être proposée en première intention pour le traitement des sténoses juxta-anastomotiques de survenue précoce après création de fistule d'hémodialyse

Amélioration de l'hyperglycémie hospitalière: création d'un nouveau modèle de gouvernance [Improvement of hospital hyperglycemia: creation of a new governance model?].

The report of significant decrease of the inpatient hospital mortality and morbidity with an efficient insulin therapy has demonstrated the need of a good glycaemic control for patients hospitalised in acute care. However, one is faced with numerous difficulties in the hospital management of patients with hyperglycaemia, errors often occur when prescribing insulin, and the management skills are insufficient. Our goal is to change the medical and nursing practices to evolve towards an efficient and safe management of the hospitalised patient. The model we lay out in this article is based upon observation of the therapeutic support of patients with a chronic condition, whilst using a systemic management approach.

Défis et opportunités liés a la création d'une société unique de spécialistes en médecine interne générale en 2015 [Challenges and opportunities related to the creation of a unique society of specialists in general internal medicine in 2015].

A common training plan in general internal medicine was a brave enterprise started in 2011 in accordance with the common objectives of the Swiss Society of General Medicine and the Swiss Society of Internal Medicine. The next challenge will be the dissolution of the two Societies and therefore the creation of an unique new association in 2015. This is an extraordinary opportunity to bring together the specific qualities of each association and to create a new society. Issues, objectives and secondary benefits expected from the creation of the largest national society of a medical discipline are explored as a joint discussion in this article.

A Legislator under Surveillance: The Creation and Implementation of Swiss Banking Legislation 1910-1934

This paper analyses how banking regulation was introduced in Switzerland - one of the world's most prominent financial centres - which remained in place until the beginning of the twenty-first century. It shows that the law adopted on 8 November 1934 is a perfect example of capture of the regulator by the regulated. Essentially a political response in the context of the economic crisis of the 1930s, it largely reflected the interests of banking circles by limiting the intervention of the State as much as possible. The introduction of the new legislation was facilitated by the temporary weakness of Swiss banking circles, as they depended on the State to delay or prevent the collapse of many major credit institutions. They did not manage to derail the law as they had two decades earlier when they scuppered the federal bill on banks drawn up between 1914 and 1916. But this time they were better organized and more united, and intervened all the more effectively in the legislative process itself. The 1934 law is thus distinctive in that it made no structural changes to the architecture of the financial centre but merely codified its practices through flexible legislation meant to reassure the public. The law was aimed less at controlling banking activity than at keeping - thanks to skilfully calibrated political concessions - the State from having to intervene more directly in the internal management of banks or in the fixing of interest rates and the export of capital.