Osteoclasts recycle via osteomorphs during RANKL-stimulated bone resorption.

Osteoclasts are large multinucleated bone-resorbing cells formed by the fusion of monocyte/macrophage-derived precursors that are thought to undergo apoptosis once resorption is complete. Here, by intravital imaging, we reveal that RANKL-stimulated osteoclasts have an alternative cell fate in which they fission into daughter cells called osteomorphs. Inhibiting RANKL blocked this cellular recycling and resulted in osteomorph accumulation.

The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study.

Background: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.

Aim: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.

Host risk factors and autochthonous hepatitis E infection.

Introduction: In developed countries autochthonous hepatitis E infection is caused by hepatitis E virus (HEV) genotype 3 or 4 and mainly affects middle aged/elderly men. Host factors might explain why older men develop clinically overt disease.

Methods: Retrospective review of 53 patients with symptomatic autochthonous hepatitis E infection to determine putative host risk factors.

Management of minor upper gastrointestinal haemorrhage in the community using the Glasgow Blatchford Score.

Background: The Glasgow Blatchford Score (GBS) is a validated risk assessment tool in primary upper gastrointestinal haemorrhage, which accurately predicts the need for intervention (endoscopic therapy, blood transfusion or surgery) or death.

Aims: To identify the GBS that predicts lack of intervention or death and to apply this to clinical practice by managing low-risk patients in the community.

Methods: GBSs prospectively calculated on 232 patients with upper gastrointestinal haemorrhage to identify low-risk score.