Baseline hypovitaminosis D is not associated with poor clinical outcomes in osteoarticular infections

OBJECTIVES Although vitamin D is recognized as an important factor in bone health, its role in osteoarticular infections is unclear. We hypothesized that low vitamin D (25-hydroxycholecalciferol) levels are associated with a lower likelihood of treatment success in osteoarticular infections. METHODS This was a retrospective cohort study of patients with orthopedic infections who had a 25-hydroxycholecalciferol level drawn when their infection was diagnosed. Outcomes were determined at early (3-6 months) and late (≥6 months) follow-up after completing intravenous antibiotics. RESULTS We included 223 patients seen during an 11-month period with osteoarticular infections and baseline 25-hydroxycholecalciferol levels. During the initial inpatient management of the infection, hypovitaminosis D was identified and treated. The mean 25-hydroxycholecalciferol level was 23±14ng/ml; 167 (75%) patients had levels <30ng/ml. Overall, infection treatment success was 91% (159/174) at early follow-up and 88% (145/164) at late follow-up. 25-Hydroxycholecalciferol baseline levels were similar in those with and without successful clinical outcomes, both at early (25±15 vs. 21±9ng/ml; p=0.3) and late follow-up (25±15 vs. 23±16ng/ml; p=0.6). CONCLUSIONS To our knowledge this is the first report on hypovitaminosis D and its impact on outcomes of osteoarticular infections. Hypovitaminosis D was frequent in this cohort. With vitamin D repletion, there was no difference in treatment success whether patients had baseline hypovitaminosis or not.

1.2 Ma stacked benthic foraminiferal carbon isotope record

Pleistocene stable carbon isotope (d13C) records from surface and deep dwelling foraminifera in all major ocean basins show two distinct long-term carbon isotope fluctuations since 1.00 Ma. The first started around 1.00 Ma and was characterised by a 0.35 per mil decrease in d13C values until 0.90 Ma, followed by an increase of 0.60 per mil lasting until 0.50 Ma. The subsequent fluctuation started with a 0.40 per mil decrease between 0.50 and 0.25 Ma, followed by an increase of 0.30 per mil between 0.25 and 0.10 Ma. Here, we evaluate existing evidence and various hypotheses for these global Pleistocene d13C fluctuations and present an interpretation, where the fluctuations most likely resulted from concomitant changes in the burial fluxes of organic and inorganic carbon due to ventilation changes and/or changes in the production and export ratio. Our model indicates that to satisfy the long-term 'stability' of the Pleistocene lysocline, the ratio between the amounts of change in the organic and inorganic carbon burial fluxes would have to be close to a 1:1 ratio, as deviations from this ratio would lead to sizable variations in the depth of the lysocline. It is then apparent that the mid-Pleistocene climate transition, which, apart from the glacial cycles, represents the most fundamental change in the Pleistocene climate, was likely not associated with a fundamental change in atmospheric pCO2. While recognising that high frequency glacial/interglacial cycles are associated with relatively large (100 ppmv) changes in pCO2, our model scenario (with burial changes close to a 1:1 ratio) produces a maximum long-term variability of only 20 ppmv over the fluctuation between 1.00 and 0.50 Ma.

Stable isotope record and age determination of ODP Site 121-758 in the northeastern Indian Ocean

Numerous studies have shown that delta18O records from benthic and planktonic foraminifera, primarily a proxy of global ice volume variations, reflect Milankovitch periodicities. To study climatic response to orbital forcing at Ocean Drilling Program site 758, we have generated continuous delta18O and delta13C records from a single benthic foraminiferal species Cibicides wuellerstorfi for the last 3.6 m.y. and extended the planktonic foraminiferal isotope records of Farrell and Janecek (1991, doi:10.2973/odp.proc.sr.121.124.1991) (0-2.5 Ma, based on Globigerinoides sacculifer) to 3.6 Ma (Chen, 1994). We then constructed an age model by matching, correlating and tuning the benthic delta18O record to a model simulation of ice volume (Imbrie and Imbrie, 1980, doi:10.1126/science.207.4434.943). The filtered 41- and 23-kyr signals based on the resultant astronomically tuned age model are highly correlated to obliquity (r=0.83) and precession (r=0.75), respectively. Although derived with methodology different from Shackleton et al. (1990) and Hilgen (1991, doi:10.1016/0012-821X(91)90206-W, 1991, doi:10.1016/0012-821X(91)90082-S), our results generally agree with their published astronomical timescales for the time interval from 0 to 3.0 Ma, providing additional support for the newly emerging chronology based on orbital tuning. Slight discrepancies exist in the time interval from 3.0 to 3.6 Ma, suggesting several possibilities, including differences in the approaches of orbital tuning and the relatively low amplitude of delta18O variations in our record. However, even if the discrepancies are due to the relatively low amplitude of the isotope signals in our record at 3.0-3.6 Ma, our resultant timescale as a whole does not adversely affect our evaluation of the paleoclimatology and paleoceanography of the Indian Ocean, such as the evolution of the 100-, 41- and 23-kyr cycles, and variation of global ice volume and deepwater temperature during the past 3.6 m.y.

Pliocene to Pleistocene calcium carbonate and organic carbon record of ODP Hole 117-722B

Site 722 provides high resolution records of percent CaCO3, magnetic susceptibility, d18O, organic carbon, and coarse fraction for the past 3.4 m.y. from the crest of the Owen Ridge, northwestern Arabian Sea. Within this time interval, most of the carbonate percent variations can be attributed to terrigenous dilution and do not reflect changes in the carbonate system. From the late Pliocene to Present, the average rate of calcium carbonate accumulation increases from 1 to 3 g/cm**2/k.y. and the average accumulation of organic carbon decreases from 75 to 30 mg/cm**2/k.y. The carbonate component is more dissolved in the older interval. The long-term variations in carbonate accumulation may reflect a greater input of organic matter in the late Pliocene, which decomposes to produce CO2 and dissolve carbonate. Magnetic susceptibility and % noncarbonate (100 - CaCO3%) reflect changes in the amount of the lithogenic component in the sediments. The period of variation of lithogenic material is the same period as the original forcing of the regional summer monsoon, however, the timing matches global aridity patterns and global ice volume (sea level) changes. This preliminary analysis suggests that the high frequency variation of lithogenic material persists for at least the last 3.4 m.y. Within the last million years, calcium carbonate accumulation has a large amplitude signal that covaries with major changes in ice volume. Both calcium carbonate and noncarbonate (mostly terrigenous) accumulation are greatest during glacial stages. Interglacial intervals are characterized by low mass accumulation rates, increased foraminifer fragmentation, and increased opal concentration. The accumulation of organic carbon matches the high frequency changes in sedimentation rates. We attribute this high correlation to enhanced preservation of organic carbon by increased sedimentation rate. Of the three major biological components studied, only opal exhibits the variations expected for a biological productivity system forced by monsoonal upwelling driven by changes in northern hemisphere summer radiation.