MORE than 80 years ago, Sir James MacKenzie1 noted: "The more I study the symptoms of heart failure, and the more I reflect on the part played by the heart muscle, the more convinced I am that... heart failure is due to the exhaustion of the reserve force of the heart muscle." Except for the cardiac glycosides, however, therapy for congestive heart failure generally has focused on the systemic signs and symptoms that appear when the failing heart becomes unable to meet the hemodynamic demands of the body, rather than on abnormalities in the heart muscle itself, which both cause . . .

Cardiomyopathy of overload. A major determinant of prognosis in congestive heart failure.

The potential for brief periods of low-magnitude, high-frequency mechanical signals to enhance the musculoskeletal system was evaluated in young women with low BMD. Twelve months of this noninvasive signal, induced as whole body vibration for at least 2 minutes each day, increased bone and muscle mass in the axial skeleton and lower extremities compared with controls. Introduction: The incidence of osteoporosis, a disease that manifests in the elderly, may be reduced by increasing peak bone mass in the young. Preliminary data indicate that extremely low-level mechanical signals are anabolic to bone tissue, and their ability to enhance bone and muscle mass in young women was inves- tigated in this study. Materials and Methods: A 12-month trial was conducted in 48 young women (15-20 years) with low BMD and a history of at least one skeletal fracture. One half of the subjects underwent brief (10 minutes requested), daily, low-level whole body vibration (30 Hz, 0.3g); the remaining women served as controls. Quantitative CT performed at baseline and at the end of study was used to establish changes in muscle and bone mass in the weight-bearing skeleton. Results: Using an intention-to-treat (ITT) analysis, cancellous bone in the lumbar vertebrae and cortical bone in the femoral midshaft of the experimental group increased by 2.1% ( p 0.025) and 3.4% ( p < 0.001), respectively, compared with 0.1% ( p 0.74) and 1.1% ( p 0.14), in controls. Increases in cancellous and cortical bone were 2.0% ( p 0.06) and 2.3% ( p 0.04) greater, respectively, in the experimental group compared with controls. Cross-sectional area of paraspinous musculature was 4.9% greater ( p 0.002) in the experimental group versus controls. When a per protocol analysis was considered, gains in both muscle and bone were strongly correlated to a threshold in compliance, where the benefit of the mechanical intervention compared with controls was realized once subjects used the device for at least 2 minute/day (n 18), as reflected by a 3.9% increase in cancellous bone of the spine ( p 0.007), 2.9% increase in cortical bone of the femur ( p 0.009), and 7.2% increase in musculature of the spine ( p 0.001) compared with controls and low compliers (n 30). Conclusions: Short bouts of extremely low-level mechanical signals, several orders of magnitude below that associated with vigorous exercise, increased bone and muscle mass in the weight-bearing skeleton of young adult females with low BMD. Should these musculoskeletal enhancements be preserved through adulthood, this intervention may prove to be a deterrent to osteoporosis in the elderly.

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Low-Level, High-Frequency Mechanical Signals Enhance Musculoskeletal Development of Young Women With Low BMD

Background Although virus-induced wheezing is common in preschool-age children, optimal management remains elusive. We examined the efficacy and safety of preemptive treatment with high-dose fluticasone in reducing the severity of recurrent virus-induced wheezing in children. Methods We randomly assigned 129 children who were 1 to 6 years of age to receive 750 μg of fluticasone propionate (ex-valve [manufacturer-measured] dose) or placebo twice daily, beginning at the onset of an upper respiratory tract infection and continuing for a maximum of 10 days, over a period of 6 to 12 months. The primary outcome was rescue oral corticosteroid use. Secondary outcomes included symptoms, use of β2-agonists, acute care visits, hospitalizations, discontinuation of the study drug, change in growth and bone mineral density, basal cortisol level, and adverse events. Results Over a median period of 40 weeks, 8% of upper respiratory tract infections in the fluticasone group led to treatment with rescue systemic corticoste...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa0808907

Preemptive use of high-dose fluticasone for virus-induced wheezing in young children.

Calorie restriction in rhesus monkeys

PURPOSE Comparison of bone age assessed using either the “atlas matching” method of Greulich and Pyle or the “point scoring system” of Tanner and Whitehouse (TW2). MATERIALS AND METHODS 362 consecutive “bone age” radiographs of the left hand and distal radius performed in a large provincial teaching hospital. Data were analysed using the “method comparison” statistical technique. Ten per cent of the radiographs were re-analysed to assess intra-observer variation. RESULTS The 95% confidence interval for the difference between the two methods was 2.28 to −1.52 years. Intra-observer variation was greater for the Greulich and Pyle method than for the TW2 method (95% confidence limit, −2.46 to 2.18 v −1.41 to 1.43). CONCLUSION The two methods of bone age assessment as used in clinical practice do not give equivalent estimates of bone age and we suggest that one method only (preferably the TW2) should be used when performing serial measurements on an individual patient.

https://adc.bmj.com/content/archdischild/81/2/172.full.pdf

Bone age assessment: a large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods

A Radiographic standard of reference for the growing hand and wrist

In 1964, this standard was prepared at the request of the National Center for Health Statistics so that the skeletal age of the bones in the growing hand and wrist could be read from the films of the children and youths–age 5 to 18 years—from 40 areas of the United States who have been included in the National Health Survey.



The major directive from the National Center was to prepare a standard so that a skeletal age could be assigned to each growing bone without any reference to the sex or the age of the subjects in the Survey.



Between 1928 and 1964, the attributes of the present standard had been tested in the United States and abroad using films of children and youths of all races and several forms of standards. The widely-used radiographic form was chosen.



Contact-size prints of 26 films of the hand and wrist were arranged as a maturity series to illustrate transitional osseous features which appear in the radiographic shadows of each bone during growth. A description of these features and standardized bone ages for males completed each standard plate.



Copies of a Manual containing the standard as used by the NHS film readers, details of its preparation, bone age equivalents for females related to the 26 standard films, and some new examples of use of bone ages will be provided for participants to this evaluation of skeletal age standards for children and youths.

Alice M. Waterhouse

Papers

A Radiographic standard of reference for the growing hand and wrist

Attributes of the radiographic standard of reference for the National Health Examination Survey

Hypertension and hypertensive heart disease

Defining the Prevalence of Heart Disease in an Examination Survey