Sexual Mixing and HIV Risk Among Ethnic Minority MSM in Britain

We conducted a cross-sectional online survey of men who have sex with men (MSM) living in Britain in 2007–2008 to examine sexual mixing among ethnic minority MSM. The sample comprised 115 black, 112 South Asian, 47 Chinese and 4,434 white MSM who reported unprotected anal intercourse (UAI) in the previous 3?months. In each ethnic minority group, MSM were three times more likely to report UAI with a partner of the same ethnicity than would be expected by chance alone (χ²?>?8.43, p?<?0.05). Nonetheless, most (>80?%) ethnic minority MSM reported UAI with men from an ethnic group other than their own. In multivariable analysis there was statistical evidence that, compared with white British MSM, self-reported HIV seropositivity remained low for South Asian and Chinese MSM after adjusting for UAI with partners of the same ethnicity (e.g. South Asian MSM, adjusted odds ratio 0.35, 95?% CI 0.19–0.66). This analysis suggests that differences in self-reported HIV seropositivity between ethnic minority and white MSM in Britain cannot be explained by sexual mixing with partners from the same ethnic group.     

Estimating self-reported sex practices,drug use,depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods

Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n?=?1352) recruited via respondent-driven sampling (RDS) (n?=?404), community popular opinion leaders (CPOL) (n?=?385), and Internet and venue-based sampling (VBS) (n?=?546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p?=?.002), income levels (p?p?p?p?=?.009), more than 10 male partners in the past 30 days (p?p?=?.001). VBS participants had lowest depression score (p?=?.005) and were more likely to report lifetime drug use (p?=?.003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.     

An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men

Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β?=??0.36; 95% CI: ?0.69, ?0.02; p?=?0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β?=??0.95; 95% CI: ?1.44, ?0.46; p?<?0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β?=??0.87; 95% CI: ?1.38, ?0.36; p?=?0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β?=?0.25; 95% CI: 0.16, 0.34; p?<?0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.     

A Comparison of MSM Stigma, HIV Stigma and Depression in HIV-Positive Latino and African American Men who have Sex with Men (MSM)

Little research has examined differences in HIV stigma versus MSM stigma and the role of these stigmas in depression for HIV-positive Latino and African American men who have sex with men (MSM), subgroups disproportionately impacted by HIV in the US. MSM stigma, HIV stigma, depression, stress and social support were examined among HIV-positive Latino (n = 100) and African American (n = 99) MSM patients at five HIV clinics in Los Angeles County, California. In multiple regression models, Latino MSM had higher HIV stigma scores (p = 0.002) but lower MSM stigma scores (p < 0.001) compared to African American MSM. General support and stress were associated with HIV stigma (p < 0.001), but not MSM stigma. Both HIV stigma (p < 0.0001) and MSM stigma (p < 0.0001) were associated with depression. These data underscore the differences in experienced stigma for Latino and African American MSM and can be used to shape effective stigma reduction programs and behavioral counseling.     

The acute effect of percutaneous mitral balloon valvuloplasty on atrial electromechanical delay and P-wave dispersion in patients with mitral stenosis

Background and aim of the study

The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters.

Materials and methods

This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5?±?8.5 years, with a mean MVA of 1.1?±?0.2 cm²) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4?±?6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values.

Results

The maximum P-wave duration (138?±?15 vs. 101?±?6 ms, p?<?0.01), PWD (58?±?18 vs 23?±?4, p?<?0.01), the interatrial (55?±?16 vs 36?±?11 ms, p?<?0.01) and left-sided intra-atrial EMD (40?±?11 vs 24?±?12 ms, p?<?0.01) were higher in patients with MS than in healthy subjects. The left atrial (LA) diameter, LA volume and LA volume index had positive association with the interatrial (r?=?0.5, p?<?0.01; r?=?0.5, p?<?0.01 and r?=?0.5, p?<?0.01, respectively) and left-sided intra-atrial EMD (r?=?0.5, p?<?0.01; r?=?0.4, p?<?0.01; r?=?0.4, p?<?0.01 respectively). After PMBV, the interatrial (55?±?16 vs. 40?±?11 ms, p?<?0.01) and left-sided intra-atrial EMD (40?±?11 vs 31?±?10, p?<?0.01) showed significant improvement compared to previous values. There was also a statistically significant difference in maximum P-wave duration and PWD between pre-and post-PMBV (138?±?15 vs 130?±?14, p?<?0.01, and 58?±?18 vs 49?±?16, p?<?0.01, respectively).

Conclusions

Our study shows that PMBV has a favorable effect on the electrocardiographic and echocardiographic parameters related with AF risk in patients with MS.     

Prevalence and risk factors of bacterial enteric pathogens in men who have sex with men: A cross-sectional study at the UK's largest sexual health service

ObjectivesOutbreaks of bacterial enteric pathogens (BEPs) in men who have sex with men (MSM) associated with antimicrobial resistance are a public health concern. We investigated the prevalence and risk factors of BEPs in MSM to inform infection control.MethodsWe conducted a cross-sectional study at a London sexual health clinic between 20/12/2017 and 06/02/2018. Residual rectal swabs from MSM attending for sexually transmitted infection (STI) testing were anonymously tested for a range of BEPs using real-time PCR. A sub-set of samples were tested for the mphA gene (a marker of azithromycin resistance). Results were linked to electronic health records.ResultsBEPs were detected in 207 of 2116 participants, giving an overall prevalence of 9.8% (95% CI 8.5%-11.1%) ranging from 0.8% (0.4%-1.2%) for Shigella to 4.9% (4.0%-5.9%) for Enteroaggregative E. coli. MSM with BEPs were more likely to have a history of bacterial STIs (p = 0.010), to report more sexual partners (p<0.001), and among HIV-negative MSM, to report current HIV pre-exposure prophylaxis use (p<0.001). Gastrointestinal symptoms were rare (1.7%) and not associated with BEPs. 41.3% of MSM with BEPs and 14.1% of those without BEPs carried mphA (p<0.001). Among the former, this was associated with a history of bacterial STIs (51.5% vs 31.1%, p = 0.003).ConclusionsOne in ten MSM had a BEP detected and most did not report symptoms. MphA carriage was common, particularly among those with BEPs. Bacterial STI treatment might contribute to selection of resistant gut organisms, emphasising the need for better antimicrobial stewardship.     

Association between perceived HIV stigma,social support,resilience, self-esteem,and depressive symptoms among HIV-positive men who have sex with men (MSM) in Nanjing,China

Among Chinese HIV-positive men who have sex with men (MSM), high levels of depression are common. The association between HIV and depression is attributed to several factors, particularly HIV-related stigma. However, to date, how HIV-related stigma leads to depression among Chinese HIV-positive MSM is still unclear. As such, this study aims to examine the relationships between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive MSM in China. We conducted a cross-sectional survey study among 347 HIV-positive MSM from July to August 2016 in Nanjing, China. Measurements were sociodemographic and psychological constructs including perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms. Structural equation modeling (SEM) was used to examine the relationships among these constructs. Overall,134 (38.6%) participants had depressive symptoms. Perceived stigma was directly associated with depressive symptoms (β?=?.196, p?<?.001). Perceived stigma also indirectly affected depressive symptoms (β?=?.200, p?<?.001)through social support and self-esteem. Social support (β?=??.124, p?=?.004) and self-esteem (β?=??.536, p?=?.001), but not resilience, were direct predictors of depressive symptoms. Resilience was directly associated with self-esteem (β?=?.512, p?<?.001). Perceived HIV stigma could directly and indirectly impact depressive symptoms in HIV-positive MSM. Improving personal self-esteem, resilience and social support might reduce impact of perceived stigma on depressive symptoms among HIV-positive MSM in China.     

Glucocorticoid treatment impairs microvascular function in healthy men in association with its adverse effects on glucose metabolism and blood pressure: a randomised controlled trial

Aims/hypothesis

Glucocorticoids (GCs) are widely used anti-inflammatory agents that frequently induce side effects, including insulin resistance, diabetes and hypertension. Here, we investigated the contribution of microvascular dysfunction to the development of these adverse effects in healthy men.

Methods

In a randomised, placebo-controlled, dose–response intervention study, 32 healthy normoglycaemic men (age: 21?±?2 years; BMI: 21.9?±?1.7 kg/m²) were allocated to receive prednisolone 30 mg once daily (n?=?12), prednisolone 7.5 mg once daily (n?=?12) or placebo (n?=?8) for 2 weeks using block randomisation. A central office performed the treatment allocation, and medication was dispersed by the hospital pharmacy that was also blinded. Treatment allocation was kept in concealed envelopes. Participants, study personnel conducting the measures and assessing the outcome were blinded to group assignment. The study was conducted at a university hospital. Primary endpoint was prednisolone-induced changes in microvascular function, which was assessed by capillary microscopy. Insulin sensitivity was determined by hyperinsulinaemic–euglycaemic clamp and postprandial glycaemic excursions by standardised meal tests.

Results

Compared with placebo, prednisolone 7.5 mg and 30 mg decreased insulin-stimulated capillary recruitment by 9?±?4% and 17?±?3%, respectively (p?<?0.01). In addition, prednisolone 7.5 mg and 30 mg reduced insulin sensitivity (M value) by ?11.4?±?4.5 μmol kg^?1 min^?1 and ?25.1?±?4.1 μmol kg^?1 min^?1 (p?<?0.001) and increased postprandial glucose levels by 11?±?5% and 27?±?9% (p?<?0.001), respectively. Only high-dose prednisolone increased systolic blood pressure (6?±?1.2 mmHg, p?=?0.006). Prednisolone-induced changes in insulin-stimulated capillary recruitment were associated with insulin sensitivity (r?=?+0.76; p?<?0.001), postprandial glucose concentrations (r?=??0.52; p?<?0.03) and systolic blood pressure (r?=??0.62; p?<?0.001). Prednisolone increased resistin concentrations, which were negatively related to insulin-stimulated capillary recruitment (r?=??0.40; p?=?0.03). No effects were noted on adiponectin and leptin concentrations. Prednisolone treatment was well tolerated; none of the participants left the study.

Conclusions/interpretation

Prednisolone-induced impairment of insulin-stimulated capillary recruitment was paralleled by insulin resistance, increased postprandial glucose levels, hypertension and increased circulating resistin concentrations in healthy men. We propose that GC-induced impairments of microvascular function may contribute to the adverse effects of GC treatment on glucose metabolism and blood pressure.

Trial registration

isrctn.org ISRTCN 78149983

Funding

The study was funded by the Dutch Top Institute Pharma T1-106.     

Postprandial microvascular function deteriorates in parallel with gradual worsening of insulin sensitivity and glucose tolerance in men with the metabolic syndrome or type 2 diabetes

Aims/hypothesis

Hyperinsulinaemia-induced whole-body glucose uptake during a euglycaemic–hyperinsulinaemic clamp is partly mediated by increased capillary density. We hypothesised that physiological insulinaemia in response to a mixed meal may also enhance microvascular function, and that this may be impaired in insulin-resistant individuals and patients with type 2 diabetes.

Methods

Twelve men with uncomplicated type 2 diabetes, 13 with metabolic syndrome and 12 age-matched healthy normoglycaemic controls, mean age 57?±?6 years, underwent skin capillary video microscopy before and 60 and 120 min following a standardised mixed meal to measure baseline capillary density (BCD) and capillary density during post-occlusive peak reactive hyperaemia (PRH), also termed capillary recruitment. Oral glucose insulin sensitivity (Matsuda index) and postprandial hyperglycaemia (2 h AUC_glucose) were calculated.

Results

Fasting BCD was similar among groups, but fasting PRH was lowest in diabetes (p?<?0.05). Postprandially, both BCD and PRH increased in all groups (p?<?0.001); however, the meal-related increase in BCD was significantly lower in diabetes and metabolic syndrome vs controls (both p?<?0.05). At all time points, postprandial PRH was lower in both diabetes and metabolic syndrome vs controls (both p?<?0.05). In pooled analysis, postprandial mean PRH correlated with Matsuda index (r?=?0.386, p?=?0.018) and inversely with 2 h AUC_glucose (r?=??0.336, p?=?0.042).

Conclusions/interpretation

Gradual deterioration in meal-related capillary recruitment was paralleled by decreasing insulin sensitivity and postprandial hyperglycaemia, as assessed in healthy normoglycaemic men, men with the metabolic syndrome and those with type 2 diabetes. These findings suggest that in both impaired glucose tolerance and in overt diabetes microvascular dysfunction might contribute to postprandial dysglycaemia.

Trial registration:

ClinicalTrials.gov NCT00721552     

Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China

ABSTRACT

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing’s Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β?=??1.37, p?<?.05) and greater endorsement of maladaptive coping (β?=?2.39, p?<?.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β?=?0.78, p?<?.05), diminished physical health (β?=??0.86, p?<?.05), and a high school or greater level of education (β?=?4.13, p?<?.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.     

Early cardiovascular remodelling in Fabry disease

Aims

Fabry disease (FD) is a rare X-linked genetic disorder caused by the deficiency or absent activity of lysosomal α-galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH).

Methods and results

This study includes subjects carrying genetic mutations for FD (Fabry disease mutation-carrier, FDMC) without LVH (n?=?19). A group of control subjects (n?=?19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow-mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33?±?1.28 vs. 10.08?±?1.63 cm/s, p?<?0.0001), longitudinal systolic strain (?18.07?±?1.72 vs. ?21.15?±?2.22 %, p?<?0.0001), significantly higher E/E’ mean values (7.15?±?1.54 vs. 5.98?±?1.27, p?=?0.016) and intima-media thickness mean values (0.80?±?0.20 vs. 0.61?±?0.19 mm, p?=?0.005), significantly lower FMD (8.3?±?4.6 vs. 12.2?±?5.0 %, p?=?0.02), more atypical capillaries and irregular NFC architecture in FDMC than control subjects (52.6 vs. 0 %, p?<?0.0001; 78.9 vs. 36.8 %, p?=?0.02 respectively).

Conclusions

FD progressively involves cardiac, macrovascular and microvascular systems in an early stage. These features are present even in asymptomatic mutation carriers without LVH.     

Predictors of medication non-adherence for vasculitis patients

The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n?=?228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence subscale (α?=?0.89). Variables that significantly correlated (p?<?0.05) with non-adherence were included in a linear regression model to predict non-adherence. Younger age (r?=??0.23, p?<?0.001), female sex (r?=?0.16, p?<?0.05), experience of side effects (r?=?0.15, p?<?0.05), and more depressive symptoms (r?=?0.22, p?<?0.001) were associated with more medication non-adherence. In the regression model, younger age (β?=??0.01, p?=?0.01) and more depressive symptoms (β?=?0.01 p?=?0.02) predicted worse adherence. For six out of eight vasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression.     

Colorectal cancer surgery remains effective with rising patient age

Background

The incidence of colorectal cancer rises disproportionally in aging persons. With a shift towards higher population age in general, an increasing number of older patients require adequate treatment. This study aims to investigate differences between young and elderly patients who undergo resection for colorectal cancer, regarding clinical characteristics, morbidity, and prognosis.

Methods

By retrospective analysis of 6 years (2007 to 2012) of a prospectively documented database, a total of 636 patients were identified who underwent oncological resection for colorectal cancer at our institution. Of this total, all 569 patients with primary colorectal adenocarcinoma were included. Four hundred ten patients were 74 years or younger and 159 were 75 years or older. The median follow-up was 22 months.

Results

Older patients had significantly more comorbidities (85 % vs. 56 %, p?<?0.001) and a higher ASA score (p?<?0.001). The mean length of stay in the hospital was longer (24 vs. 20 days, p?=?0.002), as was the length of postoperative intensive care stay (4 vs. 2 days, p?=?0.003). However, elderly patients did not have significantly higher rates of intraoperative complications or surgical morbidity. Tumor-specific 2-year survival was 83?±?4 % for the elderly and 87?±?2 % for the younger patients, which was not significantly different (p?=?0.90).

Conclusions

Long-term outcome after oncologic resection for colorectal cancer does not differ between elderly and younger patients. Age in general should not be considered as a limiting factor for colorectal cancer surgery or tumor-specific prognosis.     

Adapting the VOICES HIV Behavioral Intervention for Latino Men Who Have Sex with Men

Latino men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS, but few behavioral interventions address their prevention needs. Adaptation of evidence-based interventions is a pragmatic strategy that builds upon lessons learned and has the potential to fill gaps in prevention programming. Yet there are few reports of how transfers are executed and whether effectiveness is achieved. This research reports on the adaptation of VOICES/VOICES, a single-session intervention designed for heterosexual adults, into No Excuses/Sin buscar excuses for Latino MSM. To test the adapted intervention, 370 at-risk Latino MSM were enrolled in a randomized trial. At a three-month follow-up, there was a sharper decrease in unprotected intercourse in the intervention group compared to controls (59 % vs. 39 %, ANOVA p < 0.05, F = 4.10). Intervention participants also reported more condom use at last intercourse (AOR = 1.69; 95 % CI 1.02–2.81, p < 02). Findings support use of adapted models for meeting prevention needs of high-priority populations.     

Warm winter is associated with low incidence of ST elevation myocardial infarctions and less frequent acute coronary angiographies in an alpine country

Background

Weather conditions influence symptoms in chronic stable coronary artery disease (CAD). Whether the ongoing climate change, with continuous and rapid temperature increases, also has an impact on the incidence and outcome of non-ST elevation (NSTEMI) and ST elevation (STEMI) myocardial infarctions referred for acute coronary angiography (CA) is less clear.

Methods

According to weather data from the Institute of Meteorology and Geophysics, Innsbruck University, the 2005/2006 winter was very cold (CW) and the 2006/2007 winter extraordinarily warm (WW). As the overall invasive management of patients with acute coronary syndromes did not change substantially within these winters, we compared patients referred for acute CA suffering an acute STEMI or NSTEMI, their risk factors and in-hospital mortality rates between these two consecutive winters.

Results

As expected, the average temperature was lower (??1.6 vs. +?5.9°C; p?<?0.001) and humidity was higher (82 vs. 79%; p?<?0.012) in CW compared to WW, with no significant differences in other weather conditions (rainfall: 59 vs. 39 days; sunshine: 3.9 vs. 4.3 h/day; air pressure: 713.04 vs. 713.76 hPa). There were no differences in the number of overall CA (987 vs. 983) between these two winters, whereas the number of acute CA (12.9 vs. 10.4% of overall CA; p?=?0.046) and the diagnosis of STEMI as an indication of acute CA (74.0% vs. 62.7%; p?=?0.046) were higher in CW. Furthermore, patients in CW were younger (58.2?±?12.4 vs. 61.7?±?11.7 years; p?<?0.03), had higher LDL cholesterol (134.8?±?44.6 vs. 116.7?±?36.0 mg/dl; p?<?0.003) and were less frequently hypertensives (52.8 vs. 70.6%; p?<?0.01). Other traditional risk factors were not different between WW and CW. In addition, there were no differences in in-hospital mortality rates in invasively diagnosed CAD, patients’ nationalities (Austrians: 78.0 vs. 77.5%) and time from pain to arrival in the cath lab in STEMI patients (3.9?±?3.5 vs. 3.8?±?3.1 h).

Conclusion

The average temperature increase of 7.5°C from the cold to the warm winter was associated with a decrease in acute coronary angiographies, in particular due to a lower incidence of STEMI referred for primary percutaneous intervention.     

Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study

Aims/hypothesis

The aim of the study was to compare the effect of six (A6 regimen) vs two meals a day, breakfast and lunch (B2 regimen), on body weight, hepatic fat content (HFC), insulin resistance and beta cell function.

Methods

In a randomised, open, crossover, single-centre study (conducted in Prague, Czech Republic), we assigned 54 patients with type 2 diabetes treated with oral hypoglycaemic agents, both men and women, age 30–70 years, BMI 27–50 kg/m² and HbA_1c 6–11.8% (42–105 mmol/mol), to follow two regimens of a hypoenergetic diet, A6 and B2, each for 12 weeks. Randomisation and allocation to trial groups (n?=?27 and n?=?27) were carried out by a central computer system. Individual calculations of energy requirements for both regimens were based on the formula: (resting energy expenditure?×?1.5)???2,092 kJ. The diet in both regimens had the same macronutrient and energy content. HFC was measured by proton magnetic resonance spectroscopy. Insulin sensitivity was measured by isoglycaemic–hyperinsulinaemic clamp and calculated by mathematical modelling as oral glucose insulin sensitivity (OGIS). Beta cell function was assessed during standard meal tests by C-peptide deconvolution and was quantified with a mathematical model. For statistical analysis, 2?×?2 crossover ANOVA was used.

Results

The intention-to-treat analysis included all participants (n?=?54). Body weight decreased in both regimens (p?<?0.001), more for B2 (?2.3 kg; 95% CI ?2.7, ?2.0 kg for A6 vs ?3.7 kg; 95% CI ?4.1, ?3.4 kg for B2; p?<?0.001). HFC decreased in response to both regimens (p?<?0.001), more for B2 (?0.03%; 95% CI ?0.033%, ?0.027% for A6 vs ?0.04%; 95% CI ?0.041%, ?0.035% for B2; p?=?0.009). Fasting plasma glucose and C-peptide levels decreased in both regimens (p?<?0.001), more for B2 (p?=?0.004 and p?=?0.04, respectively). Fasting plasma glucagon decreased with the B2 regimen (p?<?0.001), whereas it increased (p?=?0.04) for the A6 regimen (p?<?0.001). OGIS increased in both regimens (p?<?0.01), more for B2 (p?=?0.01). No adverse events were observed for either regimen.

Conclusions/interpretation

Eating only breakfast and lunch reduced body weight, HFC, fasting plasma glucose, C-peptide and glucagon, and increased OGIS, more than the same caloric restriction split into six meals. These results suggest that, for type 2 diabetic patients on a hypoenergetic diet, eating larger breakfasts and lunches may be more beneficial than six smaller meals during the day. Trial registration ClinicalTrials.gov number, NCT01277471, completed. Funding Grant NT/11238-4 from Ministry of Health, Prague, Czech Republic and the Agency of Charles University – GAUK No 702312.     

Sex differences in treatment and prognosis of acute coronary syndrome with interventional management

Objective

Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital.

Mitral regurgitation recovery and atrial reverse remodeling following pulmonary vein isolation procedure in patients with atrial fibrillation: a clinical observation proof-of-concept cardiac MRI study

Background

Reverse remodeling of the left atrium (LA) following successful pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) has been well documented. However, mitral regurgitation (MR) recovery after successful PVI has never been demonstrated systematically. The objective of our study was to retrospectively analyze the effectiveness of PVI in patients with AF on recovery of MR using cardiac magnetic resonance (CMR) imaging.

Methods

Prior to PVI, patients underwent a clinically indicated CMR imaging. Post-PVI (6?±?2 months), patients underwent a follow-up MRI and were classified into two groups—responders (R) and non-responders (NR) to PVI—as assessed by cessation of AF at the end of the prespecified 6-month (14-day “P” sensitive event monitor defined) follow-up period. Furthermore, CMR was used to evaluate the severity of MR (0 to 4+) and to relate changes in MR to LA volumes as well as mitral apparatus geometry. Patients who had mild and higher MR (2+) on baseline CMR and had a post-PVI CMR were selected for final analysis.

Results

Out of the consecutive 122 patients with AF who underwent PVI, 74 patients that had mitral regurgitation on initial CMR were included in the study. Of these74 patients with AF with MR, 52 (70 %) were classified as R and 22 (30 %) were classified as NR. Baseline demographics were similar between the groups. In the subgroup with mild to severe MR, pre vs. post in the R group MR severity significantly improved (mean?=?2.3, median?=?2.0 vs. mean?=?1.0, median?=?1.0, p?<?0.0001) and was matched by favorable reverse remodeling of the mitral apparatus geometry (annulus?=?35?±?4 vs. 33?±?3 mm, p?<?0.002; tenting area?=?175?±?56 vs.137?±?37 mm², p?<?0.003; tenting height?=?8?±?2 vs.7?±?2 mm, p?<?0.02; and tenting angle?=?129?±?10° vs. 131?±?11°, p?=?0.1). However, in the NR subgroup, MR failed to improve (mean?=?2.2, median?=?2.0 vs. mean?=?1.5, median?=?1.0, p?=?NS) and paralleled general failure of mitral geometry reverse remodeling (annulus?=?35?±?4 vs. 35?±?4 mm, p?=?0.2; tenting area?=?153?±?39 vs. 152?±?34 mm², p?=?NS; tenting height?=?7?±?1 vs. 7.0?±?2, p?=?0.1; and tenting angle?=?131?±?11° vs. 133?±?10°, p?=?NS). In those with lesser degrees of MR, favorable remodeling was predicated on responder status to PVI. Similarly, other cardiac dimensions pre- to post-PVI favorably improved in the R group, but not in the NR group.

Conclusion

In those with durable maintenance of normal sinus rhythm (NSR), cardiac reverse remodeling demonstrated by 3D CMR occurs and is matched by marked improvements in MR and mitral apparatus, likely contributing to continued maintenance of NSR.     

Improved radiological outcome of rheumatoid arthritis: the importance of early treatment with methotrexate in the era of biological drugs

The objective of this study is to compare the radiological progression in patients with rheumatoid arthritis (RA) diagnosed in the 1980s with those of the late 1990s until 2005 and to evaluate prognostic factors. Ninety-two RA patients who were firstly seen in our clinic from 1997 to 2005 were identified. As a control group, 89 RA patients from 1986 to 1990 were matched for the criteria disease duration (mean, 22?±?17 months), age, and number of x-ray controls. Radiological damage was measured by the Ratingen score (RS). The baseline RS of the 1997–2005 group was significantly lower (mean, 3.8?±?8.7 vs 7.7?±?13.0; p?<?0.0001) and showed less radiological progression during follow-up than the 1986–1990 group (ΔRS/year of 0.95?±?2.19 vs. 5.69?±?8.43; p?<?0.0001). In the later group, more patients (73 vs. 28 %) had methotrexate (MTX). Twenty-one (23 %) of the patients in the later group received biological drugs. However, the subgroup 1997–2000 (n?=?29), before the approval of TNF-inhibitors, had already lower baseline RS in comparison to 1986–1990 (2.7?±?4.9; p?<?0.001). Multivariate analysis showed that early start of MTX (before or directly after first consultation) was a predictor of favorable outcome (p?<?0.005), as were low erythrocyte sedimentation rate at baseline and belonging to the later group. In contrast, neither treatment with glucocorticoids or biological drugs nor the overall rate of MTX or other disease-modifying antirheumatic drug use was predictive. Radiological damage is markedly diminished in RA patients seen since mid of the 1990s. Early treatment with MTX seems to be the key factor for this improved prognosis.