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Objective Osteoporosis and fractures are frequently encountered in patients with Crohn's disease. In order to prevent fractures, treatment with bone protecting drugs appears warranted early in the course of bone disease when bone loss is not yet prominent. We therefore aimed to demonstrate a beneficial effect on bone density of the bisphosphonate risedronate in osteopenic Crohn's disease patients. Methods This double-blind, placebo-controlled randomised trial of risedronate with calcium and vitamin D supplementation was performed in osteopenic Crohn's disease patients. Patients were treated for 2 years with follow-up after 3 and after every 6 months. Disease characteristics and activity and bone turnover markers were assessed at all visits; dual x-ray absorptiometry was performed at baseline, 12 and 24 months; radiographs of the spine at baseline and 24 months. Results Of 132 consenting patients, 131 were randomised (67 placebo and 64 risedronate). Patient characteristics were similar in both groups, although the risedronate group was slightly heavier (body mass index 24.3 vs 23.0 kg/m2). Bone mineral density at lumbar spine increased 0.04 g/cm2 on average in the risedronate group versus 0.01 g/cm2 in the placebo group (p=0.007). The mean increase in total hip bone mineral density was 0.03 versus 0.01 g/cm2, respectively (p=0.071). Fracture prevalence and incidence were similar. Change of T-scores and concentrations of bone turnover markers were consistent with a beneficial effect of risedronate when compared with placebo. The effect of risedronate was primarily demonstrated in the first 12 months of treatment. No serious unexpected suspected adverse events were observed. Conclusions A 24-month treatment course with risedronate 35 mg once weekly, concomitant with calcium and vitamin D supplementation, in osteopenic Crohn's disease patients improved bone density at lumbar spine. NTR 163 Dutch Trial Register.

Purpose Laminectomy is a standard surgical procedure for elderly patients with symptomatic degenerative lumbar stenosis. The procedure aims at decompression of the affected nerves, but it also causes a reduction of spinal shear strength and shear stiffness. The magnitude of this reduction and the influence of bone mineral density (BMD) and disc degeneration are unknown. We studied the influence of laminectomy, BMD, and disc degeneration on shear force to failure (SFF) and shear stiffness (SS). Methods Ten human cadaveric lumbar spines were obtained (mean age 72.1 years, range 53–89 years). Laminectomy was performed either on L2 or L4, equally divided within the group of ten spines. BMD was assessed by dual X-ray absorptiometry (DXA). Low BMD was defined as a BMD value below the median. Intervertebral discs were assessed for degeneration by MRI (Pfirrmann) and scaled in mild and severe degeneration groups. Motion segments L2–L3 and L4–L5 were isolated from each spine. SFF and SS were measured, while loading simultaneously with 1,600 N axial compression. Results Low BMD had a significant negative effect on SFF. In addition, a significant interaction between low BMD and laminectomy was found. In the high BMD group, SFF was 2,482 N (range 1,678–3,284) and decreased to 1,371 N (range 940–1,886) after laminectomy. In the low BMD group, SFF was 1,339 N (range 909–1,628) and decreased to 761 N (range 561–1,221). Disc degeneration did not affect SFF, nor did it interact with laminectomy. Neither low BMD nor the interaction of low BMD and laminectomy did affect SS. Degeneration and its interaction with laminectomy did not significantly affect SS. Conclusions In conclusion, low BMD significantly decreased SFF before and after lumbar laminectomy. Therefore, DXA assessment may be an important asset to preoperative screening. Lumbar disc degeneration did not affect shear properties of lumbar segments before or after laminectomy.

We investigated the safety and pharmacokinetics of (131)I-labeled chimeric monoclonal antibody MOv18 ((131)I-c-MOv18 IgG) in patients with ovarian cancer and the estimated radiation dose to cancer-free organs and tumor. Three patients were injected intravenously with 3 GBq (131)I-c-MOv18. Toxicity was evaluated according to the World Health Organization toxicity scales. Blood sampling was performed for 12 wk after injection. Whole-body and SPECT imaging was performed frequently. Dose rates were obtained with a portable dose-rate measure. Quantitative activity analysis of several organs was performed with the region-of-interest technique. Absorbed doses were calculated using MIRDOSE3. Transient changes in hematologic profiles were seen in 2 patients. Pancytopenia developed in 1 patient; on analysis, she entered the study probably with exhausted bone marrow reserves. Nonhematologic toxicity was mild. No human antichimeric antibody responses were observed. Mean isolation time was 12 d. The plasma elimination half-life increased almost 3-fold compared with that after tracer doses of c-MOv18. Dosimetry showed mean absorbed doses of 163, 380, 276, 338, 781, and 216 cGy, for whole-body, liver, kidney, spleen, lung, and red marrow, respectively. Tumor-absorbed doses ranged from 600 to 3800 cGy. All patients achieved a stable disease state, as confirmed by CT and carcinoma-associated antigen CA 125, lasting from 2 to >6 mo. (131)I-labeled c-MOv18 can safely be given to patients with noncompromised bone marrow reserves and may have therapeutic potential particularly in patients with minimal residual disease.

Immuno-PET is an appealing concept in the detection of tumors and planning of antibody-based therapy. For this purpose, the long-lived positron emitter (89)Zr (half-life, 78.4 h) recently became available. The aim of the present first-in-humans (89)Zr immuno-PET study was to assess safety, biodistribution, radiation dose, and quantification of the (89)Zr-labeled chimeric monoclonal antibody (cmAb) U36 in patients with head and neck squamous cell carcinoma (HNSCC). In addition, the performance of immuno-PET for detecting lymph node metastases was evaluated, as described previously. Twenty HNSCC patients, scheduled to undergo surgical tumor resection, received 75 MBq of (89)Zr-cmAb U36 (10 mg). Immuno-PET scans were acquired at 1, 24, 72, or 144 h after injection. The biodistribution of the radioimmunoconjugate was evaluated by ex vivo radioactivity measurement in blood and in biopsies from the surgical specimen obtained at 168 h after injection. Uptake levels and residence times in blood, tumors, and organs of interest were derived from quantitative immuno-PET studies, and absorbed doses were calculated using OLINDA/EXM 1.0. The red marrow dose was calculated using the residence time for blood. (89)Zr-cmAb U36 was well tolerated by all subjects. PET quantification of blood-pool activity in the left ventricle of the heart showed a good agreement with sampled blood activity (difference equals 0.2% +/- 16.9% [mean +/- SD]) except for heavy-weight patients (>100 kg). A good agreement was also found for the assessment of mAb uptake in primary tumors (mean deviation, -8.4% +/- 34.5%). The mean absorbed red marrow dose was 0.07 +/- 0.02 mSv/MBq and 0.09 +/- 0.01 mSv/MBq in men and women, respectively. The normal organ with the highest absorbed dose was the liver (mean dose, 1.25 +/- 0.27 mSv/MBq in men and 1.35 +/- 0.21 mSv/MBq in women), thereafter followed by kidneys, thyroid, lungs, and spleen. The mean effective dose was 0.53 +/- 0.03 mSv/MBq in men and 0.66 +/- 0.03 mSv/MBq in women. Measured excretion via the urinary tract was less than 3% during the first 72 h. (89)Zr immuno-PET can be safely used to quantitatively assess biodistribution, uptake, organ residence times, and radiation dose, justifying its further clinical exploitation in the detection of tumors and planning of mAb-based therapy.

Between-center variation in bone densitometry may influence the frequency of the diagnosis of osteoporosis. To evaluate this problem, dual-energy X-ray absorptiometry (DXA) machines of the medical centers in the northwest of The Netherlands were evaluated. Four phantoms were used to test the 17 DXA machines of 16 participating centers. Each phantom was measured 10 times and the data were analyzed on the corresponding DXA machine using the software delivered by the manufacturer. The analyses were done with the reference population as used in daily practice. There were DXA devices of seven different brands and types, using four different reference populations for the lumbar spine and seven for the hip. The observed differences in bone mineral densities (BMD) were up to 0.20 g/cm(2) for the lumbar spine, 0.15 g/cm(2) for the femoral neck, and 0.12 g/cm(2) for the total hip. The coefficients of variation (CV) of the repeated phantom measurements ranged between 0.3% and 1.3% for the lumbar spine, 1.6% and 4.6% for the femoral neck, and 0.3% and 0.9% for the total hip. The mean female T-scores of 10 phantom measurements differed up to 0.6 SD between the DXA machines for the lumbar spine and up to 0.8 SD for the total hip. Mathematically, replacing a Hologic 2000 DXA machine with a newer type of the same brand (a Hologic 4500) caused a shift in diagnosis from osteoporosis to osteopenia of +1.1% for the lumbar spine and -4.5% for the total hip. When the Hologic 2000 was replaced by a Hologic 4500 with NHANES reference values, the shift from osteoporosis to osteopenia was also +1.1% for the lumbar spine, and -13.4% for the total hip. The clinical impact of the observed differences is difficult to estimate. One may conclude that the differences of the tested DXA devices are partly based on differences in DXA machines, but for the most part on the use of different reference populations. It is recommended to standardize the reference population, although the consequent shift in diagnosis will be confusing for physicians and patients, and adaptation of the reference values on the DXA devices of different brands with different technical qualities and measurement specifications will be difficult.

Captopril-stimulated renography is widely used to screen selected groups of hypertensive patients for renal vascular disease. Evaluation of the test is a complex task. Lack of interobserver agreement on the assessment and interpretation of renographic parameters may contribute to differences in sensitivity and specificity between studies. Three experienced nuclear medicine physicians evaluated 658 renograms of 503 hypertensive patients suspected of having renal vascular disease from a large Dutch multicenter study (the Dutch Renal Artery Stenosis Intervention Cooperative [DRASTIC] study). Interobserver agreement on several renographic parameters was assessed by the kappa statistic and the intraclass correlation coefficient (ICC). The interobserver agreement on the time to excretion was high: The pooled ICC was 0.90. The pooled kappa was > or = 0.65 for the pattern of the time--activity curves, the visual aspect of the scintigraphic images (visible uptake and kidney size), and the judgment on the presence of renal artery stenosis. However, the interobserver agreement on cortical retention and pelvic retention by visual inspection of the images was rather low (pooled kappa = 0.46 and 0.52, respectively). Pelvic retention was found to complicate the interpretation of renography. Interobserver agreement on most of the renographic parameters was satisfactory, but the assessment of cortical retention was more difficult, in particular, in the presence of pelvic retention. Captopril renography should be interpreted with caution if pelvic retention is suspected. Interobserver variability offers one of several explanations for the differences in diagnostic test performance that are found between studies.

We review the “Hotel/Lodging Real Estate Industry Trends and Innovations” discussed by panelists at the Thirty-Second Annual Meeting of the American Real Estate Society in Denver, Colorado, in Spring, 2016. More specifically, based on that event’s presentations, questions, and subsequent feedback, we discuss four hotel/lodging real estate trends to suggest additional future research collaboration opportunities for academic researchers and industry practitioners. The shared lodging economy in the super-connected high-tech economy is discussed first, followed by non-traditional sources of hotel financing, new forms of boutique/lifestyle hotels/lodging, and hotel services and resort fees.

Objective: Osteoporosis and fractures are frequently encountered in patients with Crohn's disease. In order to prevent fractures, treatment with bone protecting drugs appears warranted early in the course of bone disease when bone loss is not yet prominent. We therefore aimed to demonstrate a beneficial effect on bone density of the bisphosphonate risedronate in osteopenic Crohn's disease patients.MethodsThis double-blind, placebo-controlled randomised trial of risedronate with calcium and vitamin D supplementation was performed in osteopenic Crohn's disease patients. Patients were treated for 2years with follow-up after 3 and after every 6months. Disease characteristics and activity and bone turnover markers were assessed at all visits; dual x-ray absorptiometry was performed at baseline, 12 and 24months; radiographs of the spine at baseline and 24months.ResultsOf 132 consenting patients, 131 were randomised (67 placebo and 64 risedronate). Patient characteristics were similar in both groups, although the risedronate group was slightly heavier (body mass index 24.3 vs 23.0kg/m2). Bone mineral density at lumbar spine increased 0.04g/cm2 on average in the risedronate group versus 0.01g/cm2 in the placebo group (p=0.007). The mean increase in total hip bone mineral density was 0.03 versus 0.01g/cm2, respectively (p=0.071). Fracture prevalence and incidence were similar. Change of T-scores and concentrations of bone turnover markers were consistent with a beneficial effect of risedronate when compared with placebo. The effect of risedronate was primarily demonstrated in the first 12months of treatment. No serious unexpected suspected adverse events were observed.ConclusionsA 24-month treatment course with risedronate 35mg once weekly, concomitant with calcium and vitamin D supplementation, in osteopenic Crohn's disease patients improved bone density at lumbar spine.NTR 163 Dutch Trial Register.