Bone Density Measurements Research Articles

Vitamin D during treatment for breast cancer - the perspective of active self-help group leaders.

In breast cancer patients, there is an elevated risk of developing osteoporosis during treatment which should be addressed by optimizing 25(OH) levels. The aim was to assess the prescription, information and physician-patient communication on vitamin D and bone density in Germany. We developed a standardized questionnaire concerning bone density measurement, vitamin D (blood level testing, prescription), information and communication regarding vitamin D. The questionnaire was distributed at the annual meeting of all group leaders of the Women's Cancer Support Association to all participants. Overall, 224 participants completed the questionnaire; 77.7% reported having had at least one bone density measurement test. The number was 84.4% in patients treated with aromatase inhibitor and 43.7% reported that their bone density was too low. In total, 51.3% patients reported at least one vitamin D blood test and 45.1% reported that vitamin D had been primarily addressed by a physician. As many as 74.1% of those reporting a test result had a deficiency; 91.6% of those with a low level got a prescription and 28.4% took vitamin D autonomously. The awareness on risk of osteoporosis, prevention, early diagnosis and treatment are insufficiently addressed in a patient group with high risk of osteoporosis. More attention should be paid to the phenomenon of vitamin D deficiency or insufficiency in routine care.

Remineralization of lytic spinal metastases after radiotherapy

BACKGROUND CONTEXTPalliative radiotherapy (RT) can lead to remineralization of osteolytic lesions thereby potentially restoring some of the weight-bearing capacity and preventing vertebral collapse. It is not clear, however, under which circumstances remineralization of osteolytic lesions occurs. PURPOSEThe aim of this study was to investigate the change in bone mineral density in spinal metastases after RT compared to a reference region, and find associated factors. STUDY DESIGNRetrospective analysis within prospective observational cohort OUTCOME MEASURESchange in bone mineral density measured in Hounsfield Units (HU). PATIENT SAMPLEpatients treated with RT for (painful) bone metastases. METHODSPatients with spinal metastases were included if computed tomography scans both pre- and post-RT were available. Bone density was measured in HU. A region of interest (ROI) was drawn manually in the metastatic lesion. As a reference, a measurement of bone density in adjacent, unaffected, and non-irradiated vertebrae was used. Factors tested for association were origin of the primary tumor, RT dose and fractionation scheme, and concomitant use of bisphosphonates. RESULTSA total of 31 patients with 49 spinal metastases, originating from various primary tumors, were included. The median age on baseline was 58 years (IQR: 53–63) and median time between baseline and follow-up scan was 8.2 months (IQR: 3.0–18.4). Difference in HU in the lesion before and after treatment was 146.9 HU (95% CI 68.4–225.4; p<.01). Difference in HU in the reference vertebra between baseline and first follow-up was 19.1 HU (95% CI -47.9 to 86.0; p=.58). Difference between reference vertebrae and metastatic lesions on baseline was -194.1 HU (95% CI -276.2 to -112.0; p<.01). After RT, this difference was reduced to -50.3 HU (95% CI -199.6 to 99.0; p=.52). Patients using bisphosphonates showed a greater increase in HU, 194.1 HU versus 60.6 HU, p=.01. CONCLUSIONSPalliative radiation of osteolytic lytic spinal metastases is positively associated with an increased bone mineral density at follow-up. The use of bisphosphonates was linked to an increased bone mineral density when used during or after RT.

Clinical efficacy of 1% metformin gel around conventionally placed dental implants: A 9-month follow-up study.

The study aimed to compare the clinical and radiographic outcomes of bone volume, density, and crestal bone levels in conventionally placed dental implants with and without local application of 1% metformin (MF) gel using cone-beam computed tomography (CBCT) at 9 months. Twenty implants were placed in 18 individuals, randomly divided into 2 groups where Group A received a local application of 1% MF gel along with implant placement. In contrast, Group B received implant placement alone. After thorough clinical examination and preoperative CBCTs, implants were placed under aseptic conditions. Patients were recalled at 3 and 9 months after surgery. Implants were functionally loaded by the end of 3rd month. Soft-tissue parameters such as modified plaque index and modified sulcular bleeding index were recorded along with CBCT evaluation to assess the crestal bone loss, bone density measurement, and bone volume, postoperatively. Fisher's extract test, independent and paired t-test, and Bonferroni analysis were used to determine statistical significance with P ≤ 0.05. There was no discernible difference between the groups regarding soft-tissue parameters, bone density, and crestal bone levels. However, comparing bone volume between the test and control groups at 9 months was statistically significant. The test group with 1% MF gel showed increased bone volume around the implant. The data obtained were strong enough to suggest that 1% MF gel administered locally can increase peri-implant bone volume, possibly due to its additional property favoring osteoblastic stimulation and proliferation.

Relation between Biochemical Parameters and Bone Density in Postmenopausal Women with Osteoporosis.

Osteoporosis is the most prevalent metabolic bone disease in postmenopausal women associated with reduced bone mass and increased bone fracture. Measuring bone density in the lumbar spine and hip is a reliable measure of bone mass and can therefore specify the risk of fracture. Dual-energy X-ray absorptiometry (DXA) is an accurate non-invasive system measuring bone density, with a low margin of error and no complications. The present study aimed to investigate the relationship between biochemical parameters with bone density in postmenopausal women. This cross-sectional study was conducted on 87 postmenopausal women referred to osteoporosis centers in Isfahan. Bone density was measured in the spine and hip area using the DXA system. Serum levels of calcium, phosphorus, alkaline phosphatase, and magnesium were measured by an autoanalyzer, and serum levels of vitamin D were measured by high-performance liquid chromatography (HPLC). The mean parameters of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium did not show a significant difference between the two groups (P-value > 0.05). In the control group, the relationship between alkaline phosphatase and bone mineral content (BMC) and bony area (BA) in the spine was significant with a correlation coefficient of - 0.402 and 0.258, respectively (P-value < 0.05) and BMD and T-score in the femoral neck area showed a direct and significant relationship with phosphorus (correlation = 0.368; P value = 0.038). There was a significant relationship between the Z-score with calcium (correlation = 0.358; P value = 0.044). There was no significant relationship between the values of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium parameters and bone density (spine and hip) in postmenopausal women with osteopenia or osteoporosis.

Body composition a category for resizing oncologic physical therapy: theoretical review

Movement is essential for human beings and is influenced by physical, psychological, social and environmental factors. Within the internal factors are metabolic changes, such as in body composition and interacts with comorbidities given by chronic diseases, including cancer. The role of the physiotherapist is to enhance the maximum achievable movement. Therefore, this review will seek to gather evidence on how physiotherapeutic intervention modifies body composition in pediatric oncology patients Methodology: This study is a retrospective documentary search.1 A search was carried out in PubMed, OVID and PeDro databases. The selection was carried out in three stages, the first was title review, the second abstracts, the third full text reading, and the extraction of information using the PICO format. Results: A total of 789 were found in the search, eliminated by title (n=721), by abstracts (n=56), in the complete reading (n=7). In total (n=5) were included for the final analysis. The result with the highest statistical significance was given in bone density and anthropometric measurements with a (p&lt;0.02). Conclusions: A clear relationship is found between body composition and physiotherapeutic practice in pediatric oncology. The instruments and measures that are used in the evaluation, as well as the interaction modalities, require further research, however, if an intervention such as those found in the reviewed studies, based on movement, is carried out, it would contribute to the improvement of the intervened patient and therefore the improvement of the quality of life of the affected population.

Motion grading of high-resolution quantitative computed tomography supported by deep convolutional neural networks.

Image quality degradation due to subject motion confounds the precision and reproducibility of measurements of bone density, morphology and mechanical properties from high-resolution peripheral quantitative computed tomography (HR-pQCT). Time-consuming operator-based scoring of motion artefacts remains the gold standard to determine the degree of acceptable motion. However, due to the subjectiveness of manual grading, HR-pQCT scans of poor quality, which cannot be used for analysis, may be accepted upon initial review, leaving patients with incomplete or inaccurate imaging results. Convolutional Neural Networks (CNNs) enable fast image analysis with relatively few pre-processing requirements in an operator-independent and fully automated way for image classification tasks. This study aimed to develop a CNN that can predict motion scores from HR-pQCT images, while also being aware of uncertain predictions that require manual confirmation. The CNN calculated motion scores within seconds and achieved a high F1-score (86.8±2.8%), with good precision (87.5±2.7%), recall (86.7±2.9%) and a substantial agreement with the ground truth measured by Cohen's kappa (κ=68.6±6.2%); motion scores of the test dataset were predicted by the algorithm with comparable accuracy, precision, sensitivity and agreement as by the operators (p>0.05). This post-processing approach may be used to assess the effect of motion scores on microstructural analysis and can be immediately implemented into clinical protocols, significantly reducing the time for quality assessment and control of HR-pQCT scans.

Изучение взаимосвязи состояния костной системы по данным двойной энергетической рентгеновской абсорбциометрии и локальной плотности челюстей у пациентов с адентией при планировании дентальной имплантации

Background. Timely an accurate diagnostics before the implant placement allows to get a correct anatomical rehabilitation and a satisfactory functional result. The success of dental implants in patients with osteoporosis depends primarily on the quality of the jaw bones. Aims. To study the relationship between the state of the skeletal system according to double energy X-ray absorptiometry and local density of the jaws in patients with adentia when planning dental implantation. Materials and methods. By using a densitometric method 690 patients aged between 18 to 84 years were examined prior the dental implantation. The 547 of 690 patients were women (79.3%) and 143 men (20.7%). Measurements of bone mineral density were carried out on a bone densitometer "QDR-4500A" ("Hologic"), which allows to evaluate the following parameters: elasticity, density and stiffness of the bone tissue. The study of the local density of the jaw bones was carried out by the method of cone-beam computed tomography(CBCT). Local bone density measurements were recorded in Hounsfield units (HU). Results. There is a directly proportional relationship between the results of densitometry of the axial skeleton and the density of the bone tissue of the jaws – the lower the mineral density of the bone tissue of the axial skeleton, the lower the absorption coefficient of the jaw – the Hounsfield index. As an effective sign, indicators of the state of the bone of the alveolar ridge of the lower jaw were used. The correlation between the mineral density of the skeletal system from the alveolar process of the jaws was r=0.88, which indicates a high level of feedback of these indicators. Conclusions. Diagnosis of the normal bone density, osteopenia, osteoporosis by using bone densitometry allows to determine the indications for implantation with great accuracy. There is a directly proportional relationship between the results of densitometry of the axial skeleton and the local density of the bone tissue of the jaws. Keywords: osteoporosis, densitometry (dual energy x-ray absorptiometry), dental implantation, cone beam computed tomography

The effect of bone density measurement with computed tomography on lumbosacral fusion and orientation of the sacral screw

The effect of bone density measurement with computed tomography on lumbosacral fusion and orientation of the sacral screw

Microscopic colitis is a risk factor for low bone density: a systematic review and meta-analysis.

Microscopic colitis (MC) is a chronic inflammatory disease of the large bowel characterized by watery diarrhea, substantially decreasing the patient's quality of life. Scarce data suggest that MC is associated with low bone density (LBD). We aimed to assess whether MC is a risk factor for LBD and the proportion of patients with MC having LBD. A systematic review and meta-analysis of studies reporting bone density measurements in MC patients. We systematically searched five databases from inception to October 16, 2021 (Pubmed, Embase, Cochrane, Scopus, and Web of Science). We used the random-effect model to calculate pooled odds ratios (ORs) and pooled event rates with 95% confidence intervals (CIs). To ascertain the quality of evidence of our outcomes, we followed the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. The systematic search yielded a total of 3046 articles. Four articles were eligible for quantitative synthesis. All of them used age- and sex-matched controls to evaluate LBD occurrence among patients with MC. The odds of having LBD were twofold increased (OR = 2.13, CI: 1.42-3.20) in the presence of MC, the odds of osteopenia occurrence were 2.4 (OR = 2.45, CI: 1.11-5.41), and of osteoporosis 1.4 (OR = 1.42, CI: 0.65-3.12). The proportion of LBD was 0.68 (CI: 0.56-0.78), osteopenia was 0.51 (CI: 0.43-0.58), and osteoporosis was 0.11 (CI: 0.07-0.16) among the MC population. Our findings' certainty of the evidence was very low following the GRADEPro guideline. Our data demonstrate that MC is associated with a twofold risk for LBD. Based on our findings, we suggest screening patients for bone mineral density upon diagnosis of MC. Further prospective studies with higher patient numbers and longer follow-up periods on this topic are needed. Our protocol was prospectively registered with PROSPERO (CRD42021283392).

983. Pathogen-specific PET/CT imaging for Gram negative implant-associated spinal infections

983. Pathogen-specific PET/CT imaging for Gram negative implant-associated spinal infections

Clinical And Radiographic Assessment of Xenogenic Bone Graft with or Without Hyaluronic Acid for Post Extraction Socket Preservation (Randomized Clinical Trial)

Aim: hyaluronic acid shows osteogenic potentials which considered important property during bone regeneration. So, we aim to assess the efficiency of hyaluronic acid with xenograft mixture in post extraction alveolar sockets to decelerate resorption of dental alveolar ridge. Materials and Methods: A total of twelve patients with twenty nonrestorable maxillary premolars, which were extracted atraumatically are included in this study. Twenty extracted sockets were divided randomly into two equal groups. Sockets were grafted as follows: Group (I) sockets were grafted by xenograft mixed with hyaluronic acid; Group (II) sockets were grafted by xenograft alone. CBCT scans are made for each patient to measure bone density while pain assessment was done by VAS (visual analogue scale) for pain postoperatively. Results: All preserved sockets enrolled in this study received final crowns over the abutments and the Osseo integrated implants were in fully function position without any complication. According to VAS pain recorded a higher mean value (7.4±1.35) for Group (I), in comparison to Group (II) (4.2±1.48). The differences between study and control groups were statistically significant (p=0.00). While Radiographic bone density Group (I) recorded a higher mean value (879.09±118.76), in comparison to Group (II) (546.18±123.61). The differences between study and control groups were statistically significant (p=0.00) Conclusion: The results clearly concluded that both groups are successful in achieving clinical and radiographic socket preservation with superiority for xenograft mixed with hyaluronic acid

Evaluation of the Correlation between Systemic Osteoporosis and Periodontal Status in Menopausal Women

Introduction: Periodontitis is one of the most common periodontal diseases, characterized by destruction of connective tissue and supporting structure of the tooth. Osteoporosis is a systemic disease of skeletal tissue characterized by a decrease in bone mass and leads to the destruction of bone structure. The aim of this study was to evaluate the correlation between systemic osteoporosis and periodontal status in menopausal women referred to the bone density measurement center in Gorgan.&#x0D; Materials &amp; Methods: In this case-control study, 56 menopausal women aged 45-65 years participated. Among the participants, 28 individuals had osteoporosis and 28 women were healthy. Periodontal pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and gingivitis index (GI) were measured for each patient. Finally, the data were analyzed using 95% confidence level.&#x0D; Results: A total of 56 menopausal women were included in the study. The mean GI in the osteoporotic group was 0.74 ± 1.43 and in the non-osteoporotic group was 0.77 ± 1.32 (p value = 0.280). The mean periodontal pocket depth in the osteoporotic group (0.63 ± 3.73) was more than the non- osteoporotic group 0.57 ± 3.66 (p value = 0.363). PI mean in the osteoporotic and non-osteoporotic groups were 37.11 ± 15 and 37.39 ± 15, respectively (p value = 0.363).&#x0D; Conclusion: The mean clinical attachment level in menopausal women with osteoporosis was significantly higher than normal menopausal women. On the other hand, there was no significant difference in other indices of periodontal disease such as PPD, PI, GI.

Diagnostic efficacy of radiomorphometric indices for predicting osteoporosis in a Norwegian population in the Tromsø Study: Tromsø7

The aim of this study was to investigate the diagnostic efficacy of the radiomorphometric indices of mandibular cortical width (MCW) and mandibular cortical index (MCI) of cortical erosion for osteoporosis screening in adults (≥40 years) and older adults (≥65 years) to determine whether adding a fracture risk assessment tool (FRAX) would improve efficacy. One observer measured MCW and assessed MCI on dental panoramic radiographs acquired for patients in the Tromsø study. These indices, alone and with FRAX scores, were evaluated for efficacy in predicting osteoporosis, which was diagnosed by bone density measurement at the femoral necks with dual-energy X-ray absorptiometry. MCW ≤3 mm and MCI indicating heavily eroded cortices (C3) had accuracies of 68.8% and 83.6%, respectively, in identifying osteoporosis. In females >65 years, MCW ≤3 mm and C3 produced higher sensitivities but lower specificities, with slightly lower accuracies (61.4% and 79.8%, respectively) compared with all females. The addition of FRAX scores >15% improved the accuracy of MCW ≤3 mm (81.7%) and C3 (87.9%), resulting in high specificity (86.6% and 95.4%). Combining MCW ≤3 mm or C3 with FRAX >15% increased the probabilities of detecting osteoporosis by increasing positive likelihood ratios. MCW ≤3 mm or MCI C3, when combined with FRAX >15%, showed superior diagnostic efficacy, with high specificity in detecting females without osteoporosis.

LBSAT141 Bone Health In Patients With Adrenal Disorders

Abstract Introduction Limited data suggest low bone density in patients with adrenal adenomas. However, most studies are retrospective, single-center, and none were conducted in the United States. We aimed to determine the impact of cortisol and aldosterone excess on bone density. Methods We conducted a preliminary analysis of data from our multicenter, prospective observational study of adult patients with adrenocortical hormone excess and referent subjects without adrenal disorders (January 2019 - March 2022). Patients were diagnosed with non-functioning adenomas (NFA), adenomas with mild autonomous cortisol secretion, MACS (defined as cortisol following an overnight 1-mg dexamethasone suppression test (DST)&amp;gt;1.8 mcg/dL), adrenal or pituitary Cushing syndrome (CS), primary aldosteronism (PA), and concomitant PA-MACS. Referent subjects were patients undergoing cross-sectional imaging for reasons other than adrenal disease. All participants were interviewed about their bone health, and had bone density measurements at the spine, hips, and/or radius. Bone disease was defined as osteopenia (T-score -1.1 to -2.4), or osteoporosis (T-score &amp;lt; -2.5). Results A total of 417 participants included 156 referent subjects (88, 56% women, median age 65, range 2-95 years) and 261 patients (190, 73% women, median age 59, range 21-88 years). Patients were diagnosed with NFA (51, 19%), PA (46, 17%), MACS (122, 47%), PA-MACS (12, 5%), and CS (30,12%). When compared to referent subjects, sex- and age-adjusted analysis demonstrated an increased prevalence of bone disease only in patients with CS (OR 4.8, 95%CI 1.7-13), but not in other adrenal disorders. After excluding patients with CS, those with post-DST cortisol &amp;gt;5 mcg/dL demonstrated a higher prevalence of bone disease when compared to patients with post-DST cortisol between 1.8-5 mcg/dL (OR 2.8, 95%CI 1.2-6.5) and those with post-DST cortisol &amp;lt;1.8 mcg/dL (OR 2.7, 95% CI 1.1-6.7). Patients with MACS and post-DST cortisol between 1.8-5 mcg/dL did not demonstrate increased sex and age-adjusted prevalence of bone disease compared to those with post-DST &amp;lt;1.8 mcg/dL or referent subjects. However, using post-DST cortisol as a continuous variable, we found that after adjusting for sex and age, the risk of bone disease in patients increased by 13% (OR 1.13, 95%CI 1.6-1.2) for every 1 mcg/dL increase in post-DST cortisol. Conclusions The prevalence of osteopenia and osteoporosis increases proportional to the increase in post-DST cortisol concentrations. Patients with CS, and those with MACS and post-DST cortisol &amp;gt; 5mcg/dL have the highest prevalence of bone disease. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

LIQUID PHANTOM-BASED MEASUREMENT OF JAW BONE DENSITY USING CBCT

Preoperative bone mineral density evaluation is a critical step in obtaining dental implant success. This paper summarizes the four most commonly used methods for evaluating the mineral density of jaw bone, discusses the shortcomings of these methods, and proposes a quantitative X-ray computed tomography (QCT) method for oral cone beam CT (CBCT) based on K2HPO4 liquid phantoms, in addition to describing the specific measurements. Moreover, this study evaluates K2HPO4 liquid phantoms’ uniformity, linearity, and stability in comparison with solid phantoms. The results show that CBCT bone density measurements based on K2HPO4 liquid phantoms are equivalent to those of conventional CT based on solid phantoms. In view of the low production cost and convenient and flexible configuration, the method based on liquid phantoms is worthy of clinical application.

PREFACE

PREFACE

Osteosarcopenia and type 2 diabetes mellitus in post-menopausal women: a case-control study.

Osteosarcopenia has been defined as the concomitance of low bone density (osteopenia/osteoporosis) and sarcopenia. Osteoporosis is characterized by alterations in bone microarchitecture and decrease of bone mineral density (BMD), whereas sarcopenia is the progressive decrease of both muscle mass and function that increase the risk of falls. Type 2 diabetes mellitus (T2DM) is associated with poor bone strength and muscle wasting. The aim of this study is to analyze the association between osteosarcopenia and T2DM in post-menopausal women (PMW). We performed an age matched case-control study (1:2 ratio), considering as cases PMW affected by T2DM, and PMW without T2DM as control group. For all patients a DXA evaluation to investigate bone density and body composition measures were performed. Moreover, we carried out muscle strength and performance assessments. Outcome measures were femoral neck and lumbar spine BMD T-scores, appendicular lean mass (ALM), handgrip strength and the Short Physical Performance Battery (SPPB). Data from both groups were analyzed and compared. Thirty-six PMW (12 T2DM vs 24 non-T2DM) were recruited. The frequency of osteosarcopenia was significantly higher in the T2DM group compared to controls (50% vs 17%; OR 5.0, 95% CI 1.05 to 23.79, p = 0.043). Handgrip strength was significantly lower in the T2DM group (10.09 ± 4.02 kg vs 18.40 ± 6.83 kg; p = 0.001). Post-menopausal women with T2DM have a 5 times higher risk to have osteosarcopenia compared to non-diabetic ones. Further studies on larger cohorts are required to confirm these findings.

Plain Language Summary of the International Collaborative Gaucher Group Gaucher Risk Assessment for Fracture Score in People Living with Gaucher Disease Type 1

What is Gaucher disease? Gaucher disease is a rare, inherited genetic condition. People with Gaucher disease have two non-working copies of a gene called GBA1, which contains the instructions for producing an enzyme called beta-glucosidase. Beta-glucosidase breaks down excess fatty substances called glycosphingolipids, that help maintain our cells in good working order. People with Gaucher disease do not make enough beta-glucosidase, so glycosphingolipids build up in their organs, causing complications. There are different types of Gaucher disease but most people in the Western world with Gaucher disease have type 1 (shortened to GD1). Typical complications in GD1 include having a larger spleen and liver, blood problems, and increased risk of bone problems. Bone problems, including fractures, are one of the main causes of pain and disability for people with GD1, and can impact their quality of life. Treatments such as enzyme replacement therapy (also called ERT) can reduce fracture risk but do not prevent them completely. What was the aim of this study? In this study, researchers looked at a new assessment score called the Gaucher Risk Assessment for Fracture (also known as GRAF). The aim was to evaluate how well the GRAF could predict future fracture risk in adults with GD1 who were receiving ERT. What were the findings of this study? The risk of future fractures in adults with GD1 was higher in women, and among people who had a history of bone pain or had their spleens removed as part of their treatment. Risk was also higher if people had a longer time between being diagnosed and starting treatment, and/or were older when they started ERT. The study also found that the GRAF score performed as well as other fracture risk tools used in the general population. These findings support the use of the GRAF score alongside bone density measurements and other risk factor assessments to help doctors and people with GD1 understand the risk of having a fracture after starting ERT. Clinical Trial Registration: NCT00358943 ( ClinicalTrials.gov )

Investigating the bone regeneration activity of PVA nanofibers scaffolds loaded with simvastatin/chitosan nanoparticles in an induced bone defect rabbit model

This study aims at preparing electrospun PVA NFs incorporating simvastatin/chitosan nanoparticles (SIM CS NPs) as a controlled drug eluting scaffold for bone regeneration. Optimization was performed by Design Expert® software through establishing two factor, three level factorial design, where the independent variables were the applied voltage, flow rate and PVA solution/SIM CS NPs ratio. Formulation variables values for the optimized formula were 18KV, 0.5 mL/h, and 3:1 respectively. NFs diameter and mesh pore size were chosen as the dependent variables. The optimized NFs were evaluated morphologically, chemically, and physically. Additionally, in-vitro SIM release from the scaffolds was investigated along 24 days. Optimum NFs possessed 136 nm diameter size and 6.5 nm porosity. Also, they showed sustained SIM release for 24 days to achieve the desired goal in bone regeneration. The optimized NFs were implanted within induced bone defects in rabbits. In-vivo assessments were performed through cone beam computed tomography 3D images, bone density measurements, histological analysis and bone morphogenetic protein 2 (BMP 2) level. The obtained results proved the high potential of the optimized NFs in promoting bone regeneration compared to untreated group, non-medicated NFs group, free SIM group and NFs loaded with SIM group after 6 weeks of implantation.

Long-Term Effects of Antiseizure Medications.

Most patients with epilepsy will benefit from seizure control with one of an array of chronic antiseizure medications. Knowledge of the potential long-term effects of these medications is critical to prevent adverse consequences on overall health. Antiseizure medications vary in their capacities to affect the brain and peripheral nerves, hormones, bone mineralization, cardiovascular risk, renal health, hepatic, hematological, and dermatological systems. Understanding of pathophysiology and population risk has evolved, although most of the data available are still on older generation antiseizure medications such as phenytoin, carbamazepine, and valproic acid. The enzyme-inducing properties of some antiseizure medications make their effects on cardiovascular risk and bone health detrimental. Few clear guidelines exist for monitoring long-term effects of medication therapy for epilepsy. When selecting an antiseizure medication, consideration should be given to the individual patient's risks of adverse consequences on other organ systems. During monitoring of patients on chronic therapy, screening tools such as metabolic panels and bone density measurements can help stratify risk and guide management.