The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns.

AIMS: The metabolic syndrome (MetS) is defined as a clustering of cardiovascular risk factors characterized by insulin resistance. We investigated the relationship of the MetS and its single components, defined by all six different criteria, with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality in a prospective population-based study. METHODS AND RESULTS: The MetS was defined according to the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR), the National Cholesterol Education Program (NCEP), the American College of Endocrinology (ACE), the International Diabetes Federation (IDF), and the American Heart Association (updated NCEP) criteria. We investgated the relationship of the MetS defined by aforementioned six criteria with CHD, CVD, and all-cause mortality with Cox regression analyses in a non-diabetic Finnish population of 1025 subjects, aged 65-74 years, during the 13-year follow-up. The MetS defined by all aforementioned criteria was associated with a statistically significant risk for CVD mortality when adjusted for all confounding variables (Hazards Ratios, HRs from 1.31 to 1.51). The MetS defined by the WHO, ACE, and IDF criteria was associated with an increased risk of CHD mortality (HRs from 1.42 to 1.58). There was no association between the MetS by any criteria and all-cause mortality. Of the single components of the MetS, the following predicted CVD mortality in multivariable models: impaired fasting glucose by the WHO, NCEP, and ACE criteria (HR 1.34) and by the IDF and updated NCEP criteria (HR 1.29); impaired glucose tolerance by the WHO and ACE criteria (HR 1.55); low HDL cholesterol by the EGIR criteria (HR 1.50) and by the NCEP, IDF, and updated NCEP criteria (HR 1.29); and microalbuminuria according to the WHO definition (HR 1.86). CONCLUSION: The MetS defined by all six current criteria predicts CVD mortality in elderly subjects. However, of the single components of the MetS, IFG, IGT, low HDL cholesterol, and microalbuminuria predicted CVD mortality with equal or higher HRs when compared with the different definitions of the MetS. Therefore, our study suggests that the MetS is a marker of CVD risk, but not above and beyond the risk associated with its individual components.     

Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation–rationale and design of the European CGA-TAVI registry

PurposeAortic stenosis (AS) is the most common valvular abnormality in the elderly population. For inoperable patients or those at high-risk for surgery, transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option. The aim of the “Comprehensive geriatric assessment for transcatheter aortic valve implantation” (CGA-TAVI) registry is to evaluate the effectiveness of TAVI from the perspective of the geriatrician and to identify patient characteristics and indicators related to complications and clinical benefits for patients with symptomatic severe calcified degenerative AS undergoing TAVI.Materials and methodsThe CGA-TAVI registry is an international, multi-center, prospective, observational registry across Europe with consecutive patient enrolment. The registry will enrol up to 200 patients with AS undergoing TAVI, starting August 2013. CGA-TAVI has two co-primary objectives: (1) Establish predictive value of Comprehensive geriatric assessment (CGA) for mortality and/or hospitalization in TAVI patients. (2) Demonstrate CGA changes within 3 months after TAVI. Secondary objectives are: (1) Establish predictive value of CGA in TAVI patients for all-cause hospitalization, TAVI-related hospitalization, and nursing home admission. (2) Develop a comprehensive score for the assessment of TAVI patient prognosis.ConclusionsThe data obtained from the CGA-TAVI registry will supplement previous results to document the potential value of the effectiveness of TAVI from the perspective of geriatricians and will allow the assessment of the predictive value of CGA for mortality and/or hospitalization in elderly TAVI patients.     

The Influence of In Vivo Metabolic Modifications on ADMET Properties of Green Tea Catechins–In Silico Analysis

The health effects of green tea are associated with catechins: (?)-epigallocatechin-3-O-gallate (EGCG), (?)-epigallocatechin, (?)-epicatechin-3-O-gallate, and (?)-epicatechin. An understanding of compound absorption, distribution, metabolism, excretion, and toxicity characteristics is essential for explaining its biological activities. Herein, absorption, distribution, metabolism, excretion, and toxicity properties of in vivo detected metabolites of green tea catechins (GTCs) have been analyzed in silico. The influence of metabolic transformations on absorption, distribution, metabolism, and excretion profiles of GTCs corresponds to the effects of size, charge, and lipophilicity, as already observed for other small molecules. Mutagenic, carcinogenic, or liver toxic effects were predicted only for a few metabolites. Similar to galloylated GTCs EGCG and (--)-epicatechin-3-O-gallate, the sulfo-conjugates were predicted to bind at the warfarin binding site. The low free plasma concentration of these derivatives may be consequential to their serum albumin binding. The activity cliff detected for methylated conjugates of EGCG indicates that GTCs' pro-oxidative activity in bound state comes primarily from free hydroxyl groups of the pyrogallol ring B.     

Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia

BackgroundThe objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP).MethodsA prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management.ResultsWe recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7–10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1–4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15–96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15–96.93).ConclusionType of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.     

Japanese and Non-Japanese Patients with Transient Ischemic Attack or Minor Stroke: A Five-Year Risk Analysis of Stroke and Vascular Events

Aims: We have previously reported 5-year follow-up data on the TIAregistry.org, an international prospective cohort in patients with transient ischemic attack (TIA) or minor stroke. We conducted a Japanese subgroup analysis because outcomes and predictors might differ according to ethnicities and regions. In this study, we compared the baseline and 5-year follow-up data of Japanese and non-Japanese patients with TIA or minor stroke. Methods: Patients with TIA or minor ischemic stroke within 7 days after the onset were classified into two groups based on ethnicity, Japanese ( n =345) and non-Japanese ( n =3502); further, 5-year event rates were compared between the two groups. We also determined predictors of 5-year stroke for both groups. Results: Vascular death and death from any cause were identified to be less prevalent, unlike stroke and intracranial hemorrhage, which was determined to be more prevalent in Japanese than in non-Japanese patients. Five-year rate of stroke was significantly higher in Japanese patients. Cumulative stroke and major cardiovascular event rates did not decline but instead linearly increased from 1 to 5 years in both groups. Baseline risk factors for 5-year stroke were as follows: age, diabetes, history of stroke or TIA, and congestive heart failure in Japanese patients. Independent predictors of 5-year stroke were large artery atherosclerosis, congestive heart failure, diabetes, and age in Japanese patients. Conclusions: Recurrent stroke and intracranial hemorrhage were determined to be more prevalent at 5 years after TIA or minor stroke in Japanese patients than in non-Japanese patients. Strategies to mitigate the long-term risks of stroke, aside from adherence to current guidelines, should take Japanese-patient-specific residual risks into account.     

Cardiovascular disease prediction model for Indonesian adult population with prediabetes and diabetes mellitus: The Bogor Cohort study of Noncommunicable Diseases Risk Factors

Background and aimsThis study aims to develop a predictive model of cardiovascular events in dysglycemia among the Indonesian adult population.MethodsThis is a retrospective cohort study conducted on subjects over 25 years in the “The Bogor Cohort Study of Noncommunicable Diseases Risk Factors” from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed; this included coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events.ResultsA total of 1085 subjects with prediabetes and diabetes mellitus were included in this study, with 73.5% female. The cumulative incidence of cardiovascular events in six years was 9.7%. Predictors of cardiovascular events were age ≥45 years (HR = 2.737; 95% CI 1.565–4.787) and hypertension (HR = 2.580; 95% CI 1.619–4.112).ConclusionsAge ≥45 years and hypertension were predictors of cardiovascular events in six years among the adult Indonesian population with prediabetes and diabetes, necessitating targeted intervention among these subjects.     

microRNA在急性胰腺炎患者外周血中表达的意义

目的 通过检测血清microRNA变化,预判急性胰腺炎的病情严重度并探讨影响经皮置管引流(PCD)治疗的因素.方法 回顾性分析2013年10月至2014年3月成都军区总医院收治的120例急性胰腺炎患者的临床资料并采集其外周血,35例急性重度胰腺炎(SAP)、急性中重度胰腺炎(MSAP)为A组,85例急性轻度胰腺炎(MAP)为B组.对所有患者进行APACHE Ⅱ、Reason、BISAP评分,用实时定量PCR法进行定量检测患者血清中miR-146a、miR-10b、miR-21、miR-26a表达水平,比较两组之间的4种microRNA表达差异以及与评分系统间的相关性,并分析影响PCD治疗的因素.计量资料采用t检验,变量间关系采用直线相关分析.单因素和多因素分析采用Logistic回归.结果 (1)APACHEⅡ、RANSON、BISAP评分:A组分别为(8.28±0.61)分、(3.42±0.54)分、(1.71±0.32)分;B组分别为(3.18±0.52)分、(1.43±0.25)分、(0.37±0.06)分,两组比较,差异有统计学意义(t=4.266,7.809,4.113,P＜0.05).(2)血清miR-146a、miR-10b、miR-21、miR-26a表达水平:A组分别为1.41±0.21、2.94±0.49、1.62±0.25、1.21±0.20;B组分别为6.29±0.91、0.52±0.09、2.82±0.33、3.57±0.64.miR-146a、miR-10b在两组间差异有统计学意义(=-2.156,2.110,P＜0.05),而miR-21、miR-26a两组间差异无统计学意义(t=-1.114,-1.571,P ＞0.05).(3)相关性:A组miR-146a、miR-10b与APACHEⅡ、RANSON、BISAP评分有相关性(r=-0.826、0.837,-0.874、0.866,-0.833、0.899,P＜0.05).而miR-21、miR-26a表达水平与APACHE Ⅱ、RANSON、BISAP评分无相关性(r=0.642、0.321,0.701、0.750,0.716、0.716,P＞0.05).B组miR-146a、miR-10b、miR-21、miR-26a表达水平与APACHE Ⅱ评分无相关性(r=0.067,0.347,0.133,0.111,P＞0.05);与RANSON评分无相关性(r =0.178,0.078,0.092,0.142,P＞0.05);与BISAP评分无相关性(r=0.103,0.260,0.216,0.285,P＞0.05).(4)预测因素分析:单因素Logistic回归分析发现RANSON评分、BISAP评分、miR-10b是影响PCD干预的因素(OR =4.170,5.612,2.500;95％可信区间:1.092 ～ 15.932,1.232 ～21.622,1.190 ～5.254,P＜0.05).多因素Logistic回归分析发现miR-10b是急性胰腺炎PCD干预的独立影响因素(OR=2.374,95％可信区间:1.115 ～5.056,P＜0.05).结论 miR-10b与miR-146a可能成为判断急性重症胰腺炎严重程度的预测指标;miR-10b可能成为急性胰腺炎是否行PCD干预的判定指标.     

非M3型急性白血病患者中MUC1基因和MDR1基因表达及其与临床疗效的关系

背景与目的:MUC1基因在胃癌、卵巢癌、多发性骨髓瘤、恶性淋巴瘤等肿瘤中有表达,在急性白血病患者中有较高的表达。但MUC1基因和多药耐药基因(MDR1)相互关系以及两者的表达与急性白血病治疗效果的关系尚有待探讨。本研究拟探讨MUC1基因与MDR1基因表达及其与非M3型急性白血病患者治疗效果的关系。方法:应用逆转录鄄聚合酶链反应(RT鄄PCR)法检测34例初治非M3型急性白血病患者MUC1和MDR1的表达,并观察两种基因表达及其与临床疗效的关系。结果:34例初治非M3型急性白血病患者中MUC1基因阳性率为50%,MDR1基因阳性率为29.4%。MUC1基因阳性患者的MDR1阳性率为52.9%,明显高于MUC1阴性者的5.9%(P=0.003)。MUC1基因阴性者完全缓解(CR)率达94.1%,阳性患者CR率52.9%,两组有显著性差异(P<0.05);MDR1基因阴性者CR率为91.7%,明显高于阳性患者的50.0%(P<0.05)。MUC1基因和MDR1基因均阳性者CR率为55.6%,MUC1基因和MDR1基因均阴性者16例,全部获得CR。结论:非M3型急性白血病MUC1基因阳性者MDR1基因表达率较高,MUC1基因及MDR1基因均为阴性者治疗缓解率高。提示联合检测MUC1基因和MDR1基因对判断初治非M3型急性白血病的疗效有良好的预测作用,可作为临床判断疗效的一项有意义的指标。