Mean bone mass is lower in apparently healthy young and middle-aged adult relatives of osteoporotic patients than in normal persons with no family history of osteoporosis. Our findings suggest that the failure to attain an adequate peak bone mass may play an important role in the later development of osteoporotic fractures. Relatives of osteoporotic patients should be advised to have measurements of bone mass taken. This measurement should be taken at the spine, because peripheral sites do not appear to provide adequate information about early osteoporosis.

Objective: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. Methods: We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital’s electronic medical records system. Results: Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief. Conclusion: The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.

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.) (Acceptedforpuhlicatjon .ipril 14. I9H0.) Summary. The ultrastructure oTextcnwr disitorum ton.i;n.s (EDL) and SC/CKA muscles from Iwo groups of Wistar rats obtained from dilVcrcni colonies has been examined bolh qualitatively and niorphomcirically. Compared lo sclcifi. tDL fibres are richer in sarcoplasniic rctieulum. bul contain fewer mitochondria, lipid droplets and nuclei. The quantilies of these organelles and related surface \olume ratios in single morphomctric samples varied, retleeting the heterogeneity of fibre uitraslructure within ihc musirles. There were significant dilTerences in many features quantified between the two groups of rats: these difTerences present a problem in comparing dillerent published reports bul. Ibrtunaiely. the EDL'soleus ratios were similar in both groups. Wiihin each group, the fibre fraclions occupied by mitochondria and sarcoplasmic reticulum found in the morphometnc samples were reeiprocalK related. The dilTercnl amounts of sarcoplasmic reticulum in Ihe two niuseles is insulVicieni to explain Ihe dilTerent calcium pumping capacities observed by Briggs. Poland and Soiaro (1977), suggesting a control at the level of the pump protein synthesis.

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