A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures

Background Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use.

Methods We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months' duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Participants were stratified according to treatment center, sex, and duration of symptoms (<6 weeks or 6 weeks). Outcomes were assessed at 1 week and at 1, 3, and 6 months. The primary outcome was overall pain (on a scale of 0 to 10, with 10 being the maximum imaginable pain) at 3 months.

Results A total of 78 participants were enrolled, and 71 (35 of 38 in the vertebroplasty group and 36 of 40 in the placebo group) completed the 6-month follow-up (91%). Vertebroplasty did not result in a significant advantage in any measured outcome at any time point. There were significant reductions in overall pain in both study groups at each follow-up assessment. At 3 months, the mean (±SD) reductions in the score for pain in the vertebroplasty and control groups were 2.6±2.9 and 1.9±3.3, respectively (adjusted between-group difference, 0.6; 95% confidence interval, &ndash;0.7 to 1.8). Similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement. Seven incident vertebral fractures (three in the vertebroplasty group and four in the placebo group) occurred during the 6-month follow-up period.

Conclusions We found no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, at 1 week or at 1, 3, or 6 months after treatment. (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640.)

Statphylococcus aureus bacteraemia : a major cause of mortaility in Australia and New Zealand

Objective : To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality.

Design and setting : Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008.

Main outcome measure : 30-day all-cause mortality.

Results : 1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%&ndash;63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%&ndash;25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%&ndash;22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-β-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection.

Conclusions : S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.

Age does not influence the bone response to treadmill exercise in female rats

Purpose: Because it is believed that bone may respond to exercise differently at different ages, we compared bone responses in immature and mature rats after 12 wk of treadmill running.

Methods: Twenty-two immature (5-wk-old) and 21 mature (17-wk-old) female Sprague Dawley rats were randomized into a running (trained, N = 10 immature, 9 mature) or a control group (controls, N = 12 immature, 12 mature) before sacrifice 12 wk later. Rats ran on a treadmill five times per week for 60-70 min at speeds up to 26 m[middle dot]min-1. Both at baseline and after intervention, we measured total body, lumbar spine, and proximal femoral bone mineral, as well as total body soft tissue composition using dual-energy x-ray absorptiometry (DXA) in vivo. After sacrificing the animals, we measured dynamic and static histomorphometry and three-point bending strength of the tibia.

Results: Running training was associated with greater differences in tibial subperiosteal area, cortical cross-sectional area, peak load, stiffness, and moment of inertia in immature and mature rats (P < 0.05). The trained rats had greater periosteal bone formation rates (P < 0.01) than controls, but there was no difference in tibial trabecular bone histomorphometry. Similar running-related gains were seen in DXA lumbar spine area (P = 0.04) and bone mineral content (BMC;P = 0.03) at both ages. For total body bone area and BMC, the immature trained group increased significantly compared with controls (P < 0.05), whereas the mature trained group gained less than did controls (P < 0.01).

Conclusion: In this in vivo model, where a similar physical training program was performed by immature and mature female rats, we demonstrated that both age groups were sensitive to loading and that bone strength gains appeared to result more from changes in bone geometry than from improved material properties.

Ecological processes : a key element in strategies for nature conservation

A common approach to nature conservation is to identify and protect natural 'assets’ such as ecosystems and threatened species. While such actions are essential, protection of assets will not be effective unless the ecological processes that sustain them are maintained. Here, we consider the role of ecological processes and the complementary perspective for conservation arising from an emphasis on process. Many kinds of ecological processes sustain biodiversity: including climatic processes, primary productivity, hydrological processes, formation of biophysical habitats, interactions between species, movements of organisms and natural disturbance regimes. Anthropogenic threats to conservation exert their influence by modifying or disrupting these processes. Such threats extend across tenures, they frequently occur offsite, they commonly induce non-linear responses, changes may be irreversible and the full consequences may not be experienced for lengthy periods. While many managers acknowledge these considerations in principle, there is much scope for greater recognition of ecological processes in nature conservation and greater emphasis on long time-frames and large spatial scales in conservation planning. Practical measures that promote ecological processes include: monitoring to determine the trajectory and rate of processes; incorporating surrogates for processes in conservation and restoration projects; specific interventions to manipulate and restore processes; and planning for the ecological future before options are foreclosed. The long-term conservation of biodiversity and the wellbeing of human society depend upon both the protection of natural assets and maintaining the integrity of the ecological processes that sustain them.

Neurotoxic, redox-competent Alzheimer's --amyloid is released from lipid membrane by methionine oxidation

The amyloid β peptide is toxic to neurons, and it is believed that this toxicity plays a central role in the progression of Alzheimer's disease. The mechanism of this toxicity is contentious. Here we report that an Aβ peptide with the sulfur atom of Met-35 oxidized to a sulfoxide (Met(O)Aβ) is toxic to neuronal cells, and this toxicity is attenuated by the metal chelator clioquinol and completely rescued by catalase implicating the same toxicity mechanism as reduced Aβ. However, unlike the unoxidized peptide, Met(O)Aβ is unable to penetrate lipid membranes to form ion channel-like structures, and β-sheet formation is inhibited, phenomena that are central to some theories for Aβ toxicity. Our results show that, like the unoxidized peptide, Met(O)Aβ will coordinate Cu₂₊ and reduce the oxidation state of the metal and still produce H2O2. We hypothesize that Met(O)Aβ production contributes to the elevation of soluble Aβ seen in the brain in Alzheimer's disease.

Genetic and environmental influences on variation in balance performance among female twin pairs aged 21-82 years

Genetic and environmental influences on variation in balance performance were measured in 93 monozygous and 83 dizygous female twin pairs aged 21&ndash;82 years (mean age, 50.5 years) in Melbourne, Australia, between 1999 and 2003. The authors administered clinical (Lord's Balance Test and Step Test) and laboratory tests of static and dynamic balance from the Chattecx Balance System with and without distractor tasks. The authors conducted factor analysis and estimated genetic and environmental variance components and heritability (defined as additive genetic variance as a proportion of all variance, after adjustment for age) using a multivariate normal model with the statistical package FISHER. Three factors were identified and adjusted for age. Heritability was 46% (standard error (SE), 9) for the "sensory balance tests" factor and 30% (SE, 9) for the "static and dynamic perturbations" factor. For both factors, the remaining variance was attributed to unique environmental effects. There was no evidence that genetic factors influenced variation in the "dynamic weight shift tests" factor, with environmental effects shared by twins accounting for 38% (SE, 7) of variance. Neither genetic nor environmental proportions of variance differed significantly between twin subgroups by age (≤50/>50 years). An age-related decline in performance measures was found across the whole sample. These results imply that balance impairments may have a heritable element.

Too close for comfort : a fishway exit and a hydro-power station inlet

A major environmental issue for hydro-electric power generation is passage of fish through turbines, or entrainment onto trash racks. At Yarrawonga Weir, on the upper Murray River in south-eastern Australia, the positioning of a fish lock resulted in the potential for upstream migrating fish to be swept back into the adjacent power station by cross flows. In 2004, a 4.5-m long steel extension flume was attached to the exit to alleviate this problem. To determine the fate of native fish after exiting the extension flume, 72 individuals (305&ndash;1015 mm long) were implanted with radio-transmitters and released into the fish lock exit channel. In 2004 (power station inflows 10 300 ML day^&ndash;1), the majority of fish exited successfully (44 of 45) and only a single fish (2%) was entrained into the power station. In 2005 (power station inflows 12 000 ML day^&ndash;1), fish again exited successfully (26 of 27) but with a higher proportion entrained (5 of 27; 18%). This reduced success appeared to be related to strong transverse flows with high water velocities adjacent to the fish lock exit. The efficiency of fish passage at this site might be improved by altering water management strategies, integrating engineering and fish biology, and through field-testing of proposed solutions

Anthropometric profiling of elite junior and senior Australian football players

Purpose: Body structure and physical development must be addressed when preparing junior athletes for their first season in a senior competition. The aim of this preliminary study was to measure the extent of the assumption that final year junior Australian Football (AF) athletes are at a physical mismatch to their senior counterparts.

Methods: Twenty-one male participants (17.71 ± 0.27 y) were recruited from one state based elite junior AF competition and forty-one male participants (22.80 ± 4.24 y) were recruited from one club competing in the senior elite Australian Football League (AFL), who were subsequently divided into two groups; professional rookies aged 18-20 y (19.44 ± 0.70 y; n = 18) and professional seniors aged 21+ y (25.43 ± 3.98 y; n = 23). Dual energy X-ray absorptiometry (DEXA) scans of all participants were completed.

Results: Despite being an average 6.0% and 6.1% lighter in total weight and lean mass respectively, no significant difference was found between the elite junior athletes and their professional AFL rookie counterparts. However, significant differences were demonstrated in comparison with the professional AFL senior athletes (P < .01). Both professional AFL groups demonstrated greater than 0.3 kg total bone mineral content (BMC) than the elite junior athletes (P < .01) and significantly greater segmental BMC and bone mineral density (BMD) results (P < .05).

Conclusion: While the results identify the differences in body composition of the elite junior athletes, development in a linear fashion is noted, providing useful information for the creation of age appropriate expectations and training programs.

Player movement patterns in an elite junior Australian Rules Football team : an exploratory study

This study explored the physical movement patterns associated with an elite Under 18 Australian Football (AF) team. Five field positions were selected with observations recording the number and relative per cent of "working" efforts (jogging, running, and sprinting), "resting" efforts (walking) and the total distances associated with "working" or "resting" efforts. Intra-observer reliability, using test- retest method, showed correlations were r = 0.98 or greater. The Wing position covered 11,877 m, the greatest total distance during an entire game, whilst the HBF and Centre positions both recorded 11,545 m and 11,537 m respectively and the Ruck position covered 9,203 m. The HBF recorded the greatest frequency of 'working' and 'resting' efforts (180 and 182 respectively), whilst the Wing (166 and 158), Centre (162 and 149) and Ruck (161 and 166) showed similarities in their results. The Wing position recorded the longest average distance per 'working' effort (58 m) whilst the Centre position recorded the longest average distance per 'resting' effort (17 m). Results also show the completion of less total efforts and smaller total distances, in Under 18 players, recorded compared to professional senior AF data. The results from this study suggest that further in-depth research is required into movement patterns and game activity demands in this AF playing group.

The Yo-Yo Intermittent Recovery Test (Level 1) to discriminate elite junior Australian football players

The Yo-Yo Intermittent Recovery (IR) Test is currently used to assess endurance performance in team sport athletes. However, to date, no data has been presented on its application to an elite junior Australian football (AF) playing group. Therefore, the aim of this study was to evaluate the Yo-Yo Intermittent Recovery Test Level 1 (IR1) ability to discriminate between junior AF players at two different playing standards and a group of non-athletic healthy males. Sixty age matched participants (16.6 ± 0.5 years) spread over three groups (20 per group): elite junior footballers; sub-elite junior footballers; and non-athletic healthy males participated in this study. Participants undertook a single Yo-Yo test performance on an indoor basketball court for each group. A one-way ANOVA with Scheffe's post hoc analysis revealed the elite junior footballers covered a significantly greater total distance (p < 0.001) and completed a significantly greater number of high-intensity efforts (p < 0.001) in comparison to their sub-elite counterparts, whilst both AF groups performed significantly better (p < 0.001) than the non-athletic healthy males. This study demonstrates the ability of the Yo-Yo IR1 to discriminate endurance performance between elite and sub-elite AF players, whilst further distinguishing AF players from a non-athletic healthy control group.

Reliability and validity of a reactive agility test for Australian football

Purpose: The aim of this study was to test the reliability and construct validity of a reactive agility test (RAT), designed for Australian Football (AF).

Methods: Study I tested the reliability of the RAT, with 20 elite junior AF players (17.44 ± 0.55 y) completing the test on two occasions separated by 1 wk. Study II tested its construct validity by comparing the performance of 60 participants (16.60 ± 0.50 y) spread over three aged-matched population groups: 20 athletes participating in a State Under-18 AF league who had represented their state at national competitions (elite), 20 athletes participating in the same league who had not represented their state (subelite), and 20 healthy males who did not play AF (controls).

Results: Test-retest reliability reported a strong correlation (0.91), with no significant difference (P = .22) between the mean results (1.74 ± 0.07 s and 1.76 ± 0.07 s) obtained (split 2+3). Nonparametric tests (Kruskal-Wallis and Mann-Whitney) revealed both AF groups performed significantly faster on all measures than the control group (ranging from P = .001 to .005), with significant differences also reported between the two AF groups (ranging from P = .001 to .046). Stepwise discriminant analyses found total time discriminated between the groups, correctly classifying 75% of the participants.

Conclusions: The RAT used within this study demonstrates evidence of reliability and construct validity. It further suggests the ability of a reactive component within agility test designs to discriminate among athletes of different competition levels, highlighting its importance within training activities.

Performance and anthropometric characteristics of prospective elite junior Australian footballers : a case study in one junior team

The aim of the study was to compare anthropometric and physical performance data of players who were selected for a Victorian elite junior U18 Australian rules football squad. Prior to the selection of the final training squad, 54 players were assessed using a battery of standard anthropometric and physical performance tests. Multivariate analysis (MANOVA) showed significant (p < 0.05) differences between selected and non-selected players when height, mass, 20-m sprint, agility and vertical jump height were considered collectively. Univariate analysis revealed that the vertical jump was the only significant (p < 0.05) individual test and a near significant trend (p = 0.07) for height differentiating between selected and non-selected players with medium effect sizes for all other tests except endurance. In this elite junior football squad, physical characteristics can be observed that discriminate between players selected and non-selected, and demonstrates the value of physical fitness testing within the talent identification process of junior (16&ndash;18 years) players for squad and/or team selection. Based on MANOVA results, the findings from this study suggest team selection appeared to be related to a generally higher performance across the range of tests. Further, age was not a confounding variable as players selected tended to be younger than those non-selected. These findings reflect the general consensus that, in state-based junior competition, there is evidence of promoting overall player development, selecting those who are generally able to fulfil a range of positions and selecting players on their potential.

Warming up and stretching for athletes : A meta-analysis of the research literature from 2000 to 2006 in light of current athletic practice

This review presents the methods used to investigate the effects of various stretching protocols on muscular force and performance, in light of current individual and elite athlete stretching practices in their warm-up routines. A meta-analysis of peer-reviewed articles between the years of 2000 and 2007 revealed the majority of studies support the notion that static stretching is detrimental to muscular force and performance. However, the meta-analysis also revealed that the protocols used do not necessarily match current practice with many elite athletes. This article proposes, based on the mismatch between research and practice, that further studies must address this issue in further exploring the role of stretching in pre-training and competition warm-up routines.