[Osteoporosis - whom to treat? The importance of FRAX® in Switzerland]

The WHO fracture risk assessment tool FRAX® is a computer based algorithm that provides models for the assessment of fracture probability in men and women. The approach uses easily obtained clinical risk factors (CRFs) to estimate 10-year probability of a major osteoporotic fracture (hip, clinical spine, humerus or wrist fracture) and the 10-year probability of a hip fracture. The estimate can be used alone or with femoral neck bone mineral density (BMD) to enhance fracture risk prediction. FRAX® is the only risk engine which takes into account the hazard of death as well as that of fracture. Probability of fracture is calculated in men and women from age, body mass index, and dichotomized variables that comprise a prior fragility fracture, parental history of hip fracture, current tobacco smoking, ever long-term use of oral glucocorticoids, rheumatoid arthritis, other causes of secondary osteoporosis, daily alcohol consumption of 3 or more units daily. The relationship between risk factors and fracture probability was constructed using information of nine population-based cohorts from around the world. CRFs for fracture had been identified that provided independent information on fracture risk based on a series of meta-analyses. The FRAX® algorithm was validated in 11 independent cohorts with in excess of 1 million patient-years, including the Swiss SEMOF cohort. Since fracture risk varies markedly in different regions of the world, FRAX® models need to be calibrated to those countries where the epidemiology of fracture and death is known. Models are currently available for 31 countries across the world. The Swiss-specific FRAX® model was developed very soon after the first release of FRAX® in 2008 and was published in 2009, using Swiss epidemiological data, integrating fracture risk and death hazard of our country. Two FRAX®-based approaches may be used to explore intervention thresholds. They have recently been investigated in the Swiss setting. In the first approach the guideline that individuals with a fracture probability equal to or exceeding that of women with a prior fragility fracture should be considered for treatment is translated into thresholds using 10-year fracture probabilities. In that case the threshold is age-dependent and increases from 16 % at the age of 60 ys to 40 % at the age of 80 ys. The second approach is a cost-effectiveness approach. Using a FRAX®-based intervention threshold of 15 % for both, women and men 50 years and older, should permit cost-effective access to therapy to patients at high fracture probability in our country and thereby contribute to further reduce the growing burden of osteoporotic fractures.

ARISTOTLE AND THE IMPORTANCE OF VIRTUE IN THE CONTEXT OF THE POLITICS AND THE NICOMACHEAN ETHICS AND ITS RELATION TO TODAY

While much of Aristotle's works are preserved in various volumes, two of his famous works are the Nichmachean Ethics and the Politics, both of which contain a rich compilation of ethical and political thought. In the Ethics, Aristotle describes a thorough understanding of ethical and intellectual virtue. By pursuing these virtues, Aristotle argues that a person can achieve a life of fulfilling happiness. The ideal polis as described in the Politics serves as a place where the virtuous life is attained in the best manner.Citizens who pursue virtue make the polis better, and the rulers that guide the polis ensure that the citizens have every opportunity to pursue the virtuous life. In this thesis, I see how relevant Aristotle's theory is by laying out the basic principles of the Ethics and the Politics and the connections between the two works. Indoing so, I found that Aristotle's ideal theory points out a significant flaw in our political system: the fact that we do not share a common moral conception such as the one concerned with the virtuous life as Aristotle proposes. This does not suggest thatAristotle's view was actualized during his time period, but that Aristotle conceives of an ideal life and an ideal polis that could be realized. Certainly there are issues with Aristotle's thesis concerning the inferiority of slaves and women. But what is morepoignant is the impracticality of instituting a shared common conception when today's political system permits various ideas about ethics and morality.

"Hey, Hey, He Gay, He Gay . . . Okay" . . . Or Is It?: The Sociological Importance of Bruno

Sacha Baron Cohen is a British comedian who has garnered a great deal of controversy over the years. Through his characters, Ali G, Borat, and Bruno, he attempts to trick people into letting down their guards and revealing any prejudices (racism, anti-Semitism, homophobia, misogyny, et cetera) that they may have. In doing so, each of his three characters has sparked a debate concerning the different issues they bring up: with Ali G, it was whether the character was racist or exposed racism; with Borat, it was whether the character was anti-Semitic or revealed anti-Semitism; and with Bruno, it is whether the character reinforces homophobia or mocks it. I am concerned with the last of these three debates, specifically in relation to Baron Cohen's film Bruno. Many say the film reinforces gay stereotypes and is thus harmful for the gay community, while a seemingly equal number of people say it effectively mocks homophobia and is thus beneficial for the gay community. Using the data I collected from thirty-one interviews conducted after five separate screenings of the film, I argue that Bruno is not harmful for the gay community as audiences understood that the Bruno character is based on exaggerated stereotypes of homosexuals. That is, the film did not reinforce any negative stereotypes. But, I also explain that the film did not change any opinions on homosexuality either. Also in this work, I argue that within the world of cinema, Bruno fails to fit into any pre-existing genre, including the 'mock-documentary' genre where it is most commonly placed. Rather, I suggest the film is better categorized as what I call a Real Fake Mock-documentary. While 'mock-documentaries' are made up of fictional characters in fictional situations, this new term encompasses the fact that Bruno involves a fictional character placed into real situations. I conclude by noting that the content, release, and debate surrounding Bruno all reveal that it is still difficult to bring up the issue of homosexuality in American society, even forty years after the Civil Rights era.

Impact of sex on clinical and angiographic outcomes among patients undergoing revascularization with drug-eluting stents

The goal of this study was to investigate sex-based differences in long-term clinical and angiographic outcomes after coronary revascularization with drug-eluting stents (DES).

Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds

PURPOSE: The aim of this paper is to demonstrate that computed tomography (CT) and three-dimensional (3D) CT imaging techniques can be useful tools for evaluating gunshot wounds of the skull in forensic medicine. Three purposes can be achieved: (1) identifying and recognising the bullet entrance wound - and exit wound, if present; (2) recognising the bullet's intracranial course by studying damage to bone and brain tissue; (3) suggesting hypotheses as to the dynamics of the event. MATERIALS AND METHODS: Ten cadavers of people who died of a fatal head injury caused by a single gunshot were imaged with total-body CT prior to conventional autoptic examination. Three-dimensional-CT reconstructions were obtained with the volume-rendering technique, and data were analysed by two independent observers and compared with autopsy results. RESULTS: In our experience, CT analysis and volumetric reconstruction techniques allowed the identification of the bullet entrance and exit wounds and intracranial trajectory, as well as helping to formulate a hypothesis on the extracranial trajectory to corroborate circumstantial evidence. CONCLUSIONS: CT imaging techniques are excellent tools for addressing the most important questions of forensic medicine in the case of gunshot wounds of the skull, with results as good as (or sometimes better than) traditional autoptic methods.

The evolutionary importance of cell ratio between notochordal and nucleus pulposus cells: an experimental 3-D co-culture study

Notochordal cells and nucleus pulposus cells are co-existing in the intervertebral disc at various ratios among different mammalians. This fact rises the question about the interactions and the evolutionary relevance of this phenomenon. It has been described that these relatively large notochordal cells are mainly dominant in early lifetime of all vertebrates and then differences occur with ageing. Human, cattle, sheep, and goat lose the cells with age, whereas rodents and lagomorphs maintain these throughout their lifetime.

Prognostic importance of Gleason 7 disease among patients treated with external beam radiation therapy for prostate cancer: results of a detailed biopsy core analysis

To analyze the effect of primary Gleason (pG) grade among a large cohort of Gleason 7 prostate cancer patients treated with external beam radiation therapy (EBRT).