Usefulness of mid regional pro-atrial natriuretic peptide in the exacerbations of chronic obstructive pulmonary disease

BackgroundA recent approach for the management of chronic obstructive pulmonary disease (COPD) is the measurement of systemic biomarkers. The aim of this study was to evaluate the usefulness of mid regional pro-atrial natriuretic peptide (MR-proANP) to predict short and long term prognosis.MethodsWe included 318 COPD patients: 46 in a stable phase, 217 undergoing an exacerbation and 55 with pneumonia. Serum samples were collected at admission. For 20 exacerbated patients, we also collected a second sample one month later. MR-proANP was measured by an inmunofluorescent assay.ResultsStatistically higher levels of MR-proANP were found in patients with pneumonia when comparing to patients in the stable state (p = 0.031). For those patients with paired samples, MR-proANP decreased statistically one month later (p = 0.027). MR-proANP showed significant lower levels in exacerbations with isolation of pathogenic bacteria (p = 0.011). MR-proANP levels were higher in patients that died within one month, decreasing as long as the moment of death occurred later on (p = 0.163).ConclusionsThe identification of exacerbation etiology by means of MR-proANP is not clinically reliable. Levels of MR-proANP vary depending on the clinical status, being higher during pneumonia in comparison to the stable state. MR-proANP levels were higher in patients that died within one month after the exacerbation episode.     

CYP1A1, CYP1A2 and CYBA gene polymorphisms associated with oxidative stress in COPD

BackgroundThe genetic susceptibility to chronic obstructive pulmonary disease (COPD) depends on detoxification and antioxidant enzymes, which detoxify cigarette smoke reactive components that, otherwise, generate oxidative stress.MethodsIn a case–control study of 346 subjects with and without COPD, we examined the polymorphisms 462Ile/Val, 3801T/C of CYP1A1, ?3860G/A of CYP1A2 and ?930A/G, 242C/T of CYBA individually or in combination and their contribution to oxidative stress markers by measuring malondialdehyde (MDA), catalase (CAT), glutathione (GSH) and glutathione peroxidase (GPx).ResultsCOPD patients had significantly increased MDA concentration (p < 0.001) and decreased CAT activity, GSH concentration, GPx activity (p ≤ 0.01). The patients were over-represented by the alleles 462Val, 3801C of CYP1A1 and ?930G, 242C of CYBA (p < 0.001, p = 0.003, p = 0.030 and p = 0.031, respectively) and consequently the haplotypes of same alleles i.e. 462Val:3801C, 462Val:3801T and ?930G:242C (p = 0.048, p = 0.016 and p = 0.039, respectively). Similarly, CYP1A1 and CYP1A2 haplotypes, 462Val:3860G and 462Val:3801T:3860G were significantly over-represented (p = 0.001 and p = 0.003), respectively in patients. The same alleles-associated genotype-combinations between genes were more prevalent in patients. Of note, the genotypes, 462Ile/Val+Val/Val, 3801TC+CC of CYP1A1 and ?930AG+GG of CYBA associated with increased MDA concentration (p = 0.018, p = 0.045 and p = 0.017, respectively), decreased CAT activity (p < 0.0001, p = 0.080 and p < 0.0001, respectively) and GSH concentration (p < 0.0001, p = 0.0002 and p = 0.011, respectively) in patients.ConclusionThe identified alleles, its haplotypes and the genotype-combination along with increased oxidative stress, signify the importance in susceptibility to COPD.     

Oxidative stress and myeloperoxidase activity during bacterial meningitis: Effects of febrile episodes and the BBB permeability

ObjectiveTo investigate participation of extracellular myeloperoxidase (MPO) in oxidative stress during different courses of the bacterial meningitis (BM).Materials and methodsWe sequentially assessed WBC count, blood-brain barrier (BBB) permeability, serum and cerebrospinal fluid (CSF) lipid peroxidation (LPO), MPO and antioxidative activity (AOA) in proven pediatric BM.ResultsBM patients exhibited increased systemic and local LPO and MPO, and reduced AOA, which was exaggerated in the febrile episodes. Serum MPO and LPO products were related to the BBB permeability at the baseline. CSF hydroperoxide level was influenced by the BBB permeability, CSF albumin concentration, and serum hydroperoxide (r = 0.502; p < 0.001, and r = 0.611; p < 0.001, and r = 0.358; p < 0.001, respectively). CSF hydroperoxide and MPO correlated in complicated cases during the study.ConclusionsThese results suggest that CSF LPO and MPO were closely related in BM, had different courses if febrile episodes had occurred, but were partly influenced by the BBB permeability.     

The effect of increased oxidative stress and ferritin in reducing the effectiveness of therapy in chronic hepatitis C patients

Background/aimChronic hepatitis C (CHC) patients have higher oxidative stress and ferritin than healthy individuals. However, the level of oxidative stress in CHC patients during treatment with peginterferon alpha-2a and ribavirin is not clear. The aims of our study are to investigate changes of thiobarbituric acid reactive substances (TBARS; indicated oxidative stress), total antioxidant status (TAS) and ferritin in CHC patients during therapy and to identify the correlation of these factors and the effectiveness of therapy.MethodsSixty CHC patients were selected and were prescribed 180 μg of peginteferon alpha-2a once a week and a daily dose of 1000 to 1200 mg ribavirin for 6 months. Throughout the treatment course, blood samples were taken to determine TBARS, TAS, and liver inflammation profiles including ferritin, aspartate transaminase (AST) and alanine transaminase (ALT).ResultsThe level of TBARS increased before the 12th week of therapy. Additionally, the levels of TBARS were higher in non‐rapid virological response (RVR) patients compared with RVR (p < 0.01) in baseline and therapy at the 24th week. TAS was lower during therapy than at baseline. Levels of TAS were significantly higher in sustained virological response (SVR) patients than in non-SVR (p < 0.01) in the 4th week post-therapy. We also found a positive correlation between the level of ferritin and liver inflammation during treatment (p < 0.01). The levels of ferritin and ALT were lower in SVR than in non-SVR patients in the 4th week of post-therapy (p < 0.01).ConclusionsThis study indicated that decreased ferritin, decreased TBARS and increased TAS status may improve the efficacy of treatment.     

HDL 2 Particles are associated with hyperglycaemia,lower PON1 activity and oxidative stress in type 2 diabetes mellitus patients

ObjectivesIn this study we examined the relationship of oxidative stress and hyperglycaemia to antioxidative capacity of high-density cholesterol (HDL-C) particles in type 2 diabetes mellitus (DM).Design and methodsOxidative stress status parameters (superoxide anion (O₂^?), superoxide dismutase (SOD) activity and paraoxonase (PON1) status were assessed in 114 patients with type 2 DM and 91 healthy subjects. HDL particle diameters were determined by non-denaturing polyacrylamide gradient (3–31%) gel electrophoresis.ResultsPatients had significantly higher concentrations of oxidative stress parameter O₂^?(p < 0.001) and antioxidative defence, SOD activity (p < 0.001). Paraoxonase activity was significantly lower in diabetics (p < 0.001). The PON1₁₉₂ phenotype distribution among study groups was not significantly different. HDL 3 phenotype was significantly prevalent among patients (p < 0.001). Paraoxonase activity was significantly lower in patients with predominantly HDL 2 particles than in controls.ConclusionsThe results of our current study indicate that the diabetic HDL 2 phenotype is associated with hyperglycaemia, lower PON1 activity and elevated oxidative stress.     

Self-reported physical activity behaviour; exercise motivation and information among Danish adult cancer patients undergoing chemotherapy

BackgroundPhysical activity is considered an important and determining factor for the cancer patient's physical well-being and quality of life. However, cancer treatment may disrupt the practice of physical activity, and the prevention of sedentary lifestyles in cancer survivors is imperative.PurposeThe current study aimed at investigating self-reported physical activity behaviour, exercise motivation and information in cancer patients undergoing chemotherapy.Methods and sampleUsing a cross-sectional design, 451 patients (18–65 years) completed a questionnaire assessing pre-illness and present physical activity; motivation and information received.ResultsPatients reported a significant decline in physical activity from pre-illness to the time in active treatment (p < 0.001). Amongst the respondents, 68% answered that they believed exercise to be beneficial; and 78% claimed not exercising as much as desired. Exercise barriers included fatigue (74%) and physical discomfort (45%). Present physical activity behaviour was associated with pre-illness physical activity behaviour (p < 0.001), exercise belief (p < 0.001), and diagnosis (p < 0.001). More patients <40 years than patients >40 years (OR 0.36, p < 0.001); more men than women (OR 2.12, p < 0.001); and more oncological than haematological patients (OR 0.41, p < 0.001) stated being informed about physical activity. Moreover patients who claimed to have been informed about exercise were more in agreement with being able to exercise while undergoing chemotherapy (OR 1.69, p = 0.023).ConclusionsThis study suggests that Danish adult cancer patients in chemotherapy experience a significant decline in physical activity behaviour. Results indicate a general positive interest in physical activity amongst the patients, which however may be only suboptimally exploited.     

Plasma osteopontin concentration correlates with the severity of hepatic fibrosis and inflammation in HCV-infected subjects

BackgroundThe association between OPN level and the histological severity of hepatic fibrosis and inflammation in hepatitis C virus (HCV) induced liver fibrosis remains unknown.Methods120 chronic HCV-infected subjects and 75 controls were enrolled in this study. Assessment of liver histology was performed based on liver biopsy. Plasma OPN levels were determined.ResultsSignificant differences were noted in the mean plasma OPN levels between subjects with extensive fibrosis and those with mild fibrosis (4.29 ± 1.01 ng/ml vs. 2.15 ± 0.63 ng/ml, respectively; p < 0.001). Similarly, the subjects with higher histological activity index (HAI) score had elevated OPN levels than those with mild HAI score (4.41 ± 1.11 ng/ml vs. 2.25 ± 0.94 ng/ml, respectively; p < 0.001). The correlation between the plasma OPN levels and the severity of liver fibrosis degree and HAI score were noted (r = 0.945, and r = 0.788, respectively both p < 0.001). Logistic regression analysis showed that serum OPN was an independent risk factor contributing to extensive liver fibrosis and inflammation (p = 0.0018 and p < 0.001, respectively) in patients with HCV subjects.ConclusionThe plasma OPN level is correlated with the severity of liver fibrosis and inflammation, suggesting OPN could be used as a biomarker to evaluate the severity of liver damages in HCV subjects.     

Antioxidant status and lipid peroxidation in the blood of breast cancer patients of different ages after chemotherapy with 5-fluorouracil,doxorubicin and cyclophosphamide

ObjectivesBreast carcinoma is related to the increase of lipid peroxidation in plasma with concomitant decrease of antioxidant (AO) defense capacity in blood cells, which becomes more pronounced during aging of the patients. This work evaluated the potential age-related effect of chemotherapy with 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) on the level of lipid hydroperoxides (LP), glutathione (GSH), AO enzyme activities of copper, zinc superoxide dismutase (CuZnSOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) in breast cancer patients. The level of CuZnSOD protein was assessed after the FAC therapy and radiotherapy of breast cancer.Design and methodsAO parameters were measured in the blood of 58 breast cancer patients and 60 healthy age-matched healthy subjects by biochemical and Western blot analyses.ResultsIncreased oxidative stress (LP: p < 0.05) and decreased AO enzyme activities (CuZnSOD: p < 0.01, GPx: p < 0.05, GR: p < 0.01) and GSH level (p < 0.01) in the blood of breast cancer patients in response to FAC chemotherapy seem not to be age-dependent. CuZnSOD enzyme expression decreased after the FAC chemotherapy (p < 0.05), while it increased after the radiotherapy of breast cancer (p < 0.05).ConclusionFAC chemotherapy and radiotherapy promote further oxidative shift, which potentiate already existing chronic oxidative stress linked to breast cancer. In these effects, impaired capacity for H₂O₂ detoxification (CAT, GPX and GSH) seems to have major contribution.     

Antioxidative enzymes and increased oxidative stress in depressive women

ObjectivesTo investigate the activities of the main antioxidative enzymes and oxidative stress in women with depressive disorder (DD).MethodsIn 35 drug-naive women with DD and 35 age matched healthy women enzymes superoxide dismutase (CuZnSOD), catalase (CAT), glutathione peroxidase (GPX1), glutathione reductase (GR) and paraoxonase (PON1), concentrations of conjugated dienes (CD), reduced glutathione (GSH) and anthropometric and clinical data were investigated.ResultsWomen with DD were found to have decreased activities of GPX1 (p < 0.05), decreased concentrations of GSH (p < 0.05), and increased activities of GR (p < 0.05), CuZnSOD (p < 0.001), and concentrations of CD (p < 0.05). Activity of GPX1 was positively correlated with concentration of GSH (p < 0.05). Concentrations of CD were positively correlated with TG (p < 0.01).ConclusionOur set of depressive women was characterized by changes indicating an increased oxidative stress, as well as by certain features of metabolic syndrome.     

Diagnostic performance of BNP and NT-ProBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies

ObjectivesTo test the diagnostic performance of BNP and NT-ProBNP in children with different hemodynamic dysfunctions.Design and methodsSeventy children who underwent echocardiography and were classified into left and right ventricle volume and pressure overload (LVvO, LVpO, RVvO, and RVpO, respectively) and biventricular volume overload (BVvO) were enrolled.ResultsBNP and NT-ProBNP levels in all groups were higher than those in the control group (p < 0.001, p < 0.001). The increase in peptide levels was strongly correlated with the severity of heart failure (p < 0.001, p < 0.001). There was no significant difference in peptide levels in-between LVvO, LVpO, RVvO, RVpO and BVvO groups. Both measurements were significantly correlated (r = 0.76, p < 0.001) with each other. NT-ProBNP showed a high sensitivity, whereas BNP showed a high specificity and accuracy. AUCs in ROC-curve were 0.97 for BNP and 0.96 for NT-ProBNP.ConclusionsNT-ProBNP may be used in screening of risk groups for cardiac failure because of its' higher sensitivity, but BNP may be specifically used in monitoring patients with heart failure.     

Impact of radiotherapy and chemotherapy on biomarkers of oxidative DNA damage in lung cancer patients

ObjectivesTo assess oxidative damage to DNA during lung cancer (LC) treatments.Design and methodsUrinary levels of 8-oxoguanine (8-oxoGua) and levels of 8-oxo-2′-deoxyguanosine (8-oxodG) from urine and whole blood were determined in 36 non-cancer controls and 65 LC patients before any treatments. Samples were also obtained of LC patients during and after radiotherapy (RT, n = 33) and chemotherapy (CT, n = 16).ResultsStage IV LC patients had higher urinary 8-oxoGua and 8-oxodG levels than patients with stage I–III disease (p = 0.044 and p = 0.034, respectively). Urinary 8-oxodG levels increased during the first week of RT (p < 0.001). Nuclear 8-oxodG increased during RT and 3 months after start of RT. Nuclear 8-oxodG levels also rose between the first two CT cycles (p = 0.043), and urinary 8-oxodG levels during the sixth CT cycle (p = 0.009).ConclusionsUrinary DNA damage biomarker levels may be associated with LC stage. Both RT and CT increase the parameters of DNA oxidation.     

Lower limb alignment and laxity measures before,during and after total knee arthroplasty: A prospective cohort study

BackgroundThis study compared knee alignment and laxity in patients before, during and after total knee arthroplasty, using methodologically similar procedures, with an aim to help inform pre-operative planning.MethodsEighteen male and 13 female patients were recruited, mean age 66 years (51–82) and mean body mass index of 33 (23–43). All were assessed pre- and postoperatively using a non-invasive infrared position capture system and all underwent total knee arthroplasty using a navigation system. Knee kinematic data were collected and comparisons made between preoperative clinical and intraoperative measurements for osteoarthritic knees, and between postoperative clinical and intraoperative measurements for prosthetic knees.FindingsThere was no difference in unstressed coronal mechanical femoral-tibial angles for either osteoarthritic or prosthetic knees. However, for sagittal alignment the knees were in greater extension intraoperatively (osteoarthritic 5.2° p < 0.001, prosthetic 7.2° p < 0.001). For osteoarthritic knees, both varus and valgus stress manoeuvres had greater angular displacements intraoperatively by a mean value of 1.5° for varus (p = 0.002) and 1.6° for valgus (p < 0.001). For prosthetic knees, only valgus angular displacement was greater intraoperatively (0.9°, p = 0.002).InterpretationSurgeons performing total knee arthroplasties should be aware of potential differences in alignment and laxity measured under different conditions to facilitate more accurate operative planning and follow-up.     

Efectividad de un programa de mejora para la calidad de los registros enfermeros en ginecología y obstetricia

ObjectivesTo evaluate the effect of a program to improve nursing documentation on the quality and quantity of the nursing records in the Obstetrics and Gynecology Units of the Hospital Clínico San Carlos (Madrid, Spain).MethodA quasi-experimental, pretest-posttest study was performed. The medical records of patients in the Obstetrics and Gynecology Unit were analyzed. The intervention was developed from January to May, 2005. The medical records of discharged patients were evaluated from January to December 2004 and from January to May 2005. In addition, the medical records of 50% of the patients admitted in December 2004 and June 2005 were randomly selected and audited. The variables analyzed were: 1) the number of records with a nursing discharge report, nursing care plan, and evaluation of the aims set, and 2) the number of nursing care plans and the coherence of these plans.ResultsStatistically significant differences were found in obstetrics (OBS) and gynecology (GYN) in the following variables: “discharge with evaluation of the aims set”: OBS, 2004 (20.6%), 2005 (57.6%), p < 0.001; GYN, 2004 (14.4%) and 2005 (54.6%), p < 0.001; “patients discharged with nursing care plans”: OBS, 2004 (95.5%), 2005 (98.8%), p < 0.001; GYN, 2004 (84.2%), 2005 (88.8%), p < 0.001; “coherence of the nursing care plan”: OBS, December 2004 (15.4%), June 2005 (93.7%), p < 0.001; GYN, December 2004 (28,6%), June 2005 (73%) p < 0.02.ConclusionsThe intervention was effective. Variables indicating quality (discharge with evaluation of the aims set and coherence of the nursing care plan) were significantly increased. The number of patients discharged with a nursing care plan also increased.     

Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients

ObjectiveThe aim of this study was to assess the role of blood lactate levels at admission in carbon monoxide (CO)-poisoned patients for establishing severity of poisoning and short term prognosis.MethodAll cases of CO poisoning visited in the emergency department during the years 2012 and 2013 were retrieved from the hospital database. The concentration of COHb and lactate was assessed in arterial blood in all patients with suspected CO poisoning, along with the plasma concentration of troponin I (TnI). The control population for TnI results consisted in 125 blood donors.ResultsTwenty three (61%) out of 38 CO-poisoned patients underwent hyperbaric oxygen (HBO) treatment, and 10 (26%) were admitted to a hospital ward. A significant correlation was found between lactate and COHb (r = 0.54; p < 0.001), and between lactate and TnI (r = 0.44; p = 0.001). A significant correlation was also found between COHb and TnI (r = 0.38; p = 0.020). Blood lactate levels were higher in patients treated with HBO and hospital admission. In multivariate analysis, none of the parameters was associated with HBO treatment, whereas increased value of blood lactate (p = 0.036) was the only significant predictor of hospital admission. Twenty five (66%) patients had detectable TnI levels compared to 13% controls (p < 0.001), whereas 16% CO-poisoned patients had TnI levels > 99th percentile compared to 2% controls (p = 0.003). The odds ratio for detectable TnI and TnI > 99th percentile in CO-poisoned patients were 13.1 (p < 0.001) and 7.6 (p = 0.006), respectively.ConclusionInitial blood lactate level may be useful for risk stratification of CO-poisoned patients, especially for predicting hospitalization.     

Plasma resistin levels are associated with homocysteine,endothelial activation,and nitrosative stress in obese youths

ObjectiveTo evaluate whether serum resistin levels are related to cardiovascular risk in obese children.Design and methodsCross-sectional study of 110 children (40 normal weight and 70 severely obese). Clinical and biochemical parameters, including lipid profile, fasting glucose and insulin, and homocysteine, were determined. The levels of adipokines (adiponectin, leptin, and resistin), markers of inflammation (high-sensitivity C-reactive protein (hs-CRP)), endothelial activation (serum concentrations of soluble intercellular and vascular cellular adhesion molecule-1 (sICAM-1, sVCAM-1)), and oxidative/nitrosative stress (malondialdehyde and urinary nitrate/nitrite) were measured.ResultsA partial correlation adjusted by gender, Tanner stage, and body mass index in obese children showed that resistin was significantly related to central obesity (p < 0.002), insulin resistance (p < 0.005), and homocysteine (p < 0.001). No association was found with other metabolic risk factors or hs-CRP levels. Malondialdehyde (p < 0.043) and sVCAM-1 (p < 0.002) were positively correlated whereas urinary nitrate/nitrite was negatively correlated (p < 0.007). In multiple regression analysis homocysteine, sVCAM-1, and urinary nitrate/nitrite remained independent determinants of resistin levels (R² adjusted = 0.347, p = 0.000).ConclusionsResistin could be considered as a promising marker for future cardiovascular disease in obese children.     

Relation between riboflavin,flavin mononucleotide and flavin adenine dinucleotide concentrations in plasma and red cells in patients with critical illness

BackgroundThere is some evidence that the relationship between plasma and red cell vitamin B2 concentrations is perturbed in the critically ill patient. The aim of the present study was to examine the longitudinal interrelationships between riboflavin, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) in plasma and red cells in patients with critical illness.MethodsRiboflavin, FMN and FAD concentrations were measured, by HPLC, in plasma and red cells in healthy subjects (n = 119) and in critically ill patients (n = 125) on admission and on follow-up.ResultsOn admission, compared with the controls, critically ill patients had significantly higher plasma riboflavin and FMN concentrations (p < 0.001) and lower median plasma FAD concentrations (p < 0.001). In the red cell, FAD concentrations were significantly lower in critically ill patients (p < 0.001). In healthy subjects, plasma riboflavin was directly associated with both plasma FMN (r_s = 0.55, p < 0.001) and plasma FAD (r_s = 0.49, p < 0.001). Red cell riboflavin was directly associated with red cell FMN (r_s = 0.52, p < 0.001) but not red cell FAD. In the critically ill patients, plasma riboflavin was not significantly associated with either plasma FMN or FAD. Red cell riboflavin was directly associated with red cell FMN (r_s = 0.79, p < 0.001) and red cell FAD (r_s = 0.72, p < 0.001). Longitudinal measurements (n = 60) were similar.ConclusionsThe relationship between plasma riboflavin, FMN and FAD was significantly perturbed in critical illness. This effect was less pronounced in red cells. Therefore, red cell FAD concentrations are more likely to be a reliable measure of status in the critically ill patient.     

Increased serum oxidative stress in patients with severe mitral regurgitation: A new finding and potential mechanism for atrial enlargement

ObjectiveThe aim of this study was to examine the serum oxidative stress in patients with severe mitral regurgitation.Design and methodsThis study analyzed serum oxidative stress index in patients with severe mitral regurgitation [persistent atrial fibrillation (AF) or sinus rhythm], paroxysmal lone AF patients and healthy subjects.ResultsThe serum oxidative stress index was significantly higher in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p < 0.0001). Left atrial size was significantly larger in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p < 0.0001). The oxidative stress index significantly and positively correlated with left atrial size in the overall study population (r = 0.439, p = 0.0008).ConclusionsThis study provides new evidence of increased oxidative stress in human severe mitral regurgitation, probably contributing to atrial enlargement.     

The circulating concentration and ratio of total and high molecular weight adiponectin in post-menopausal women with and without osteoporosis and its association with body mass index and biochemical markers of bone metabolism

ObjectivesThere is increasing evidence suggesting that adiponectin plays a role in the regulation of bone metabolism.Design and methodsThis was a cross-sectional study of 34 post-menopausal women with and 37 without osteoporosis. All subjects had body mass index (BMI), bone mineral density (BMD), total-, high molecular weight (HMW)-adiponectin and their ratio, osteoprotegerin (OPG), a marker of bone resorption (βCTX) and formation (P1NP) measured.ResultsWe observed a positive correlation between BMI and BMD (r = 0.44, p < 0.001). When normalised for BMI, total-, HMW-adiponectin concentrations and HMW/total-adiponectin ratio were significantly lower in obese compared to lean subjects but there was no difference between those with or without osteoporosis. There were significant negative correlations between HMW/total-adiponectin ratio and BMI (r = ? 0.27, p = 0.030) and with OPG (r = ? 0.44, p < 0.001).ConclusionsOur data suggests that there is no significant difference in the circulating concentration of fasting early morning total- or HMW-adiponectin in post-menopausal women with or without osteoporosis. The correlation between HMW/total-adiponectin ratio and OPG may indicate that adiponectin could influence bone metabolism by altering osteoblast production of OPG thereby affecting osteoclasts mediated bone resorption.     

Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest – A new early marker of favorable outcome?

BackgroundBradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) indicates less neurological damage and therefore would be associated with lower mortality.MethodsWe studied 234 consecutive comatose survivors of OHCA with presumed cardiac etiology and shockable primary rhythm, who underwent a full 24-h TH-protocol (33 °C) at a tertiary heart center (years: 2004–2010). Primary endpoint was 180-day mortality; secondary endpoint was favorable neurological outcome (180-day cerebral performance category: 1–2).ResultsSB, defined as sinus rhythm <50 beats per minute during TH, was present in 115 (49%) patients. Baseline characteristics including sex, witnessed arrest, bystander cardiopulmonary resuscitation and time to return of spontaneous circulation were not different between SB- and no-SB patients. However, SB-patients were younger, 57 ± 14 vs. 63 ± 14 years, p < 0.001 and less frequently had known heart failure (7% vs. 20%, p < 0.01).Patients experiencing SB during the hypothermia phase of TH had a 17% 180-day mortality rate compared to 38% in no-SB patients (p < 0.001), corresponding to a 180-day hazard ratio (HR_adjusted = 0.45 (0.23–0.88, p = 0.02)) in the multivariable analysis. Similarly, SB during hypothermia was directly associated with lower odds of unfavorable neurological outcome (OR_unadjusted = 0.42 (0.23–0.75, p < 0.01).ConclusionSinus bradycardia during therapeutic hypothermia is independently associated with a lower 180-day mortality rate and may thus be a novel, early marker of favorable outcome in comatose survivors of OHCA.     

Insulin resistance in early untreated rheumatoid arthritis patients

ObjectivesTo assess insulin resistance in early untreated rheumatoid arthritis patients and its relation to the clinical, inflammatory and biochemical characteristics of these patients.Patients and methodsSixty-six untreated rheumatoid arthritis (RA) patients with disease duration less than 1 year along with age and sex matched controls were studied. Disease activity score (DAS28) was used to assess disease activity. Plasma levels of C- reactive protein (CRP), glucose, insulin and complete lipid profile were measured. Insulin resistance (IR) was estimated by the homeostasis model assessment for insulin resistance (HOMA-IR).ResultsRA patients revealed high grade systemic inflammation compared to control group p < 0.0001. Patients with high disease activity were more insulin resistant than patients with moderate disease activity P < 0.0001.ConclusionThe findings of the present study showed that early untreated RA patients are characterized by a severe insulin resistant state that is driven primarily by disease activity and systemic inflammation.