塞拉利昂西区拉沙热血清流行病学调查

目的 了解拉沙热在塞拉利昂西区流行和分布情况。方法 用随机抽样的方式采集并检测了820份塞拉利昂西区人群血清中的拉沙热IgG抗体,并分析其分布特征。结果 总体拉沙热IgG抗体阳性率为 28.78%,95%可信区间(Confidence Interval, CI)为25.68%~31.88%。拉沙热阳性率西区郊区43.48%(80/184),高于西区城市24.82%(136/548)(χ²=23.06, P<0.05),差异有统计学意义;不同性别和不同年龄组之间拉沙热阳性率差异无统计学意义。结论 塞拉利昂西区拉沙热总体阳性率较高,且郊区和城市差异明显,应加强环境卫生的改善,加大防鼠灭鼠工作。     

Beta 3-adrenergic receptor gene polymorphism and type 2 diabetes in a Caucasian population

Summary
Aim   The β₃-adrenergic receptor (β₃-AR) is suspected to play a key role in the regulation of energy balance by increasing lipolysis and thermogenesis. A mutation in the β₃-AR gene (Trp64Arg) has been associated with the capacity of weight gain and with early onset of noninsulin dependent diabetes mellitus (type 2 diabetes). In this study we investigated the prevalence of the two β₃-AR alleles in a Caucasian population and studied the association between the β₃-AR genotype and metabolic disorders (obesity and type 2 diabetes).
Methods   Genomic DNA extracted from peripheral blood leucocytes of 200 Caucasian subjects (137 subjects with and 63 subjects without type 2 diabetes). The Mva I polymorphism of β₃-AR, which detects the Trp64Arg mutation, was determined by polymerase chain reaction (PCR). We studied the correlation between the Trp64Arg mutation and the body mass index (b.m.i. kg/m²).
Results   There was no significant difference between the patients with type 2 diabetes and control subjects in the frequency of the Arg64 allele (5.5% and 4.8%, respectively). Within the group of type 2 diabetes patients were 14 subjects with the Trp64Arg mutation (b.m.i., mean ± s.d.: 31 ± 8.5 kg/m²) and 123 without the mutation (b.m.i. 29 ± 4.8). There was no association between the β₃-AR gene polymorphism and sex, obesity, blood pressure, glycohaemoglobin concentration, proteinuria.
Conclusion   Our results suggest that the Trp64Arg mutation is not a major determinant of metabolic disorders (type 2 diabetes, obesity) and chronic complications of type 2 diabetes in a Dutch population.     

Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India

Rapid urbanization and accompanying lifestyle changes in India lead to transition in non-communicable disease risk factors.
A survey was done in urban, urban slum and rural population of Haryana, India, in a sample of 4129 men and 3852 women using WHO STEPS questionnaire.
A very high proportion of all the three populations reported inadequate intake of fruits and vegetables. Rural men reported five times physical activity as compared with urban and urban slum men and rural women reported seven times physical activity as compared with women in the other two settings. Mean body mass index (BMI) was highest among urban men (22.8 kg m⁻²) followed by urban slum (21.0 kg m⁻²) and rural men (20.6 kg m⁻²) ( P -value < 0.01). Similar trend was seen for women but at a higher level than men. Prevalence of obesity (BMI ≥ 30 kg m⁻²) was highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum (male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%).
Urbanization increases the prevalence of the studied non-communicable disease risk factors, with women showing a greater increase as compared with men. Non-communicable disease control strategy needs to address urbanization and warrants gender sensitive strategies specifically targeting women.     

Aortic calcification is associated with age and sex but not left ventricular mass in essential hypertension

The aim of this study was to investigate the prevalence of aortic calcification in patients with essential hypertension and its relationship with age, sex, and left ventricular hypertrophy. Two hundred ninety consecutive patients with essential hypertension were studied. A chest radiograph and an echocardiograph were performed. Aortic calcification was observed in 74/290 (25.5%) patients. Patients with calcification were mostly female (67.6%) and older (71.8±1.9 years), whereas patients without calcification were younger (59.0±0.79) and of both sexes (51.85% female). Left ventricular mass index in male patients with aortic calcification was 147.3±4.32 g/m² and without calcification was 132.7±2.28 g/m² ( p= 0.023). Female patients' values were 131.9±4.32 g/m² with calcification and 121.2±2.85 g/m² without calcification ( p= 0.025). Left ventricular mass was independently associated with age and sex but not with aortic calcification. The prevalence of aortic calcification in essential hypertension is considerably higher compared to the general population. Essential hypertension and age seem to contribute to the concurrent appearance of aortic calcification and increased left ventricular mass.     

Validation of the NAFLD fibrosis score in a Chinese population with low prevalence of advanced fibrosis

OBJECTIVES:  Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence worldwide. This study aimed to validate the NAFLD fibrosis score in the Chinese population.
METHODS:  NAFLD patients were prospectively recruited for liver biopsy and blood tests. The NAFLD fibrosis score was calculated as −1.675 + 0.037 × age (yr) + 0.094 × BMI (kg/m²) + 1.13 × impaired fasting glucose/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio–0.013 × platelet (×10⁹/L)−0.66 × albumin (g/dL). Advanced fibrosis was defined as stage 3 to 4 fibrosis.
RESULTS:  One hundred sixty-two patients (age 46 ± 10 yr, male 59%) were included in the study. Advanced fibrosis was found in 18 (11%) patients. Only 11 of 128 patients with the NAFLD fibrosis score below the proposed low cutoff point (<−1.455) were under-staged, resulting in a high negative predictive value of 91%. Only two patients exceeded the proposed high cutoff point (>0.676), but neither had advanced fibrosis. If the NAFLD fibrosis score was implemented in the Chinese population, 79% of liver biopsies could be avoided.
CONCLUSIONS:  The NAFLD fibrosis score has high negative predictive value in excluding advanced fibrosis in the Chinese population, and can reduce the burden of liver biopsy in the vast majority of cases. Since there were few cases of advanced fibrosis in this cohort, this study had limited power in validating the high cutoff point.     

Systemic Hemodynamic Changes in Elderly Hypertensive Patients After Ingesting Foods With Lipid, Protein, and Carbohydrate Contents

Aging is associated with changes in cardiovascular structure and function, which predisposes elderly people to reduced blood pressure levels after meals. The authors studied cardiac systolic function in elderly hypertensive patients after eating meals with different contents of lipids, proteins, and carbohydrates. Ten elderly male hypertensive patients were studied (mean age, 69 years; range 60–80 years). No patients had a previous history of orthostatic or postprandial hypotension. Patients ate 1 of 3 pre-prepared meals: lipid meal (LM), protein meal (PM), or carbohydrate meal (CM), on different days. Mean arterial pressure, total peripheral resistance index (TPRi), cardiac index (CI), and stroke index were recorded at the end of the fasting period and then at 5, 15, 30, 45, and 60 minutes after food ingestion. After ingestion of a CM, the CI increased from 2.30±0.21 L/min/m² to 2.61±0.24 L/min/m² and the TPRi decreased from 3212±226 dynes/sec² to 2793±255 dynes/sec² at 45 minutes (P<.05). After the LM, the CI increased from 2.15±0.15 to 2.84±0.27 L/min/m² and the TPRi decreased from 3630±274 L/min/m² to 2666±282 dynes/sec² at 45 minutes (P<.05). After the PM, no systemic hemodynamic changes were observed. When all 3 meals were compared, the highest values of CI and the lowest values of TPRi were observed for the LM and CM. The authors' results show that fat- and carbohydrate-rich foods cause changes in the systemic hemodynamic of the elderly hypertensive patients.     

A population pharmacokinetic model for pegylated-asparaginase in children

We analysed 1221 serum activity measurements in 168 children from the Berlin-Frankfürt-Münster acute lymphoblastic leukaemia studies, ALL-BFM (Berlin-Frankfürt-Münster) 95 and ALL-BFM REZ, in order to develop a pharmacokinetic model describing the activity-time course of pegylated (PEG)-asparaginase for all dose levels. Patients received 500, 750, 1000 or 2500 U/m² PEG-asparaginase on up to nine occasions. Serum samples were analysed for asparaginase activity and data analysis was done using nonlinear mixed effects modelling (NONMEM Vers. VI, Globomax, Hanouet, MD, USA). Different linear and nonlinear models were tested. The best model applicable to all dosing groups was a one-compartmental model with clearance (Cl) increasing with time according to the formula: Cl=Cl_i * e ^{(0·0793 * t )} where Cl_i = initial clearance and t  = time after dose. The parameters found were: volume of distribution ( V ) 1·02 ± 26% l/m², Cl_i 59·9 ± 59% ml/d per m² (mean ± interindividual variability). Interoccasion variability was substantial with 0·183 l/m² for V and 44·7 ml/d per m² for Cl, respectively. A subgroup of the patients showed a high clearance, probably due to the development of inactivating antibodies. This is the first model able to predict the activity-time course of PEG-asparaginase at different dosing levels and can therefore be used for developing new dosing regimens.     

Insulin glulisine, insulin lispro and regular human insulin show comparable end-organ metabolic effects: an exploratory study

Aims:  To compare the end-organ metabolic effects of insulin glulisine (glulisine), insulin lispro (lispro) and regular human insulin (RHI) in patients with type 1 diabetes mellitus.
Methods:  Eighteen patients with type 1 diabetes mellitus (mean age 36.9 ± 8.6 years, BMI 23.6 ± 2.8 kg/m², haemoglobin A_1c 7.4 ± 0.9%) were randomized in this single-centre, double-blind, three-period cross-over, standard Latin-square, euglycaemic glucose clamp trial. Patients received sequential, primed stepwise intravenous infusions of glulisine, lispro or RHI (infusion rates were increased in a stepwise manner from an initial rate of 0.33 [180 min] to 0.66 [180 min] and 1.00 [180 min] mU/kg/min). The primary variables were the suppression of endogenous glucose production ( S _EGP) and glucose uptake (GU).
Results:  Mean basal endogenous glucose production (EGP) was 1.88, 2.12 and 2.12 mg/kg/min for glulisine, lispro and RHI respectively. Mean (±s.e.) maximum absolute S _EGP (adjusted for basal EGP) was −1.64 ± 0.06, −1.72 ± 0.05 and −1.56 ± 0.05 mg/kg/min respectively. Mean (±s.e.) maximum absolute increase in GU (adjusted for basal GU) was 6.46 ± 0.26, 6.23 ± 0.24 and 6.72 ± 0.24 mg/kg/min respectively. There were no clinically relevant differences between the three insulin treatments with respect to serum insulin, free fatty acid (FFA), glycerol or lactate levels. No serious adverse events and no episodes of severe hypoglycaemia were reported.
Conclusions:  This study shows that glulisine, lispro and RHI have similar effects on S _EGP, GU, FFA, glycerol and lactate levels, providing evidence for similar end-organ metabolic effects.     

The coming epidemic of obesity in elderly Americans

Objectives: To estimate the prevalence of obesity in elderly Americans in 2010 and to discuss the health and economic implications of these estimates.
Design: Three methods of generating future point-prevalence estimates using data from consecutive cross-sectional studies.
Setting: All regions of the United States.
Participants: Estimates were based on five nationally representative surveys of the adult population of the United States, conducted from 1960 to 2000, and population estimates from the U.S. Census Bureau.
Measurements: Changes in obesity (body mass index (BMI) ≥30 kg/m²) and normal weight (BMI <25 kg/m²) prevalence for men and women by 10-year U.S. birth cohorts were examined. The prevalence of obesity and normal weight in the elderly in 2010 was estimated under three different scenarios of obesity prevalence change.
Results: It was estimated that the prevalence of obesity in adults aged 60 and older will increase from 32.0% in 2000 to 37.4% in 2010 (range 33.6–39.6%). The number of obese adults aged 60 and older will increase from 14.6 to 20.9 million (range 18.8–22.2 million). Similarly, it was estimated that the prevalence of normal weight among adults aged 60 and older will decrease from 30.6% in 2000 to 26.7% in 2010 (range 31.0–24.7%).
Conclusion: The prevalence of obesity in elderly Americans will likely continue to increase, challenging healthcare delivery and financing systems in the United States.     

The European Exenatide study of long-term exenatide vs. glimepiride for type 2 diabetes: rationale and patient characteristics

Aim: To describe the rationale for the European Exenatide (EUREXA) clinical study and describe the characteristics of the patient cohort.
Methods: EUREXA is a multinational study of long-term effects of add-on exenatide vs. glimepiride in patients with type 2 diabetes and failure of diet/lifestyle plus metformin monotherapy. Metformin failure was defined as hemoglobin A1c (HbA1c) ≥ 6.5% and patients were overweight/obese (BMI ≥ 25 to < 40 kg/m²). The primary end point is time to failure of combination treatment, defined from HbA1c concentration according to current criteria. At baseline, an oral glucose tolerance test (OGTT) was performed, fasting blood was taken for lipid profile and patients were randomized to add-on exenatide (5 μg b.i.d. for 4 weeks then 10 μg b.i.d.) or glimepiride (1 mg/day titrated to maximum dose).
Results: A total of 1039 patients were entered in the study, with mean (± s.d.) age 57.2 ± 9.6 years, body mass index (BMI) 32.4 ± 4.1 kg/m², duration of diabetes 5.6 ± 4.5 years and HbA1c 7.4 ± 0.7%. A history of cardiovascular disease (CVD) was present for 64.8% of patients overall and duration of diabetes was statistically significantly longer for patients with CVD than without (p = 0.010). Lipid abnormalities were reported for 48.9% of patients and 40.9% were taking at least one lipid-lowering medication.
Conclusion: Patients included in the EUREXA study had early failure of glucose control with metformin and presented typical features of type 2 diabetes: overweight/obesity and high prevalence of lipid abnormalities and CVD. In this population, the effects of exenatide vs. glimepiride will be evaluated over at least 2.5 years.     

Augmentation index in resistance to thyroid hormone (RTH)

Objective  Resistance to thyroid hormone (RTH) is associated with a varied clinical presentation. The cardiac effects of RTH have been described but vascular function has yet to be fully evaluated in this condition. We have measured the arterial function of those with RTH to assess any vascular changes.
Design  An observational study.
Patients  Twelve RTH patients were recruited from the thyroid clinic (mean value ± SD), age 40·8 ± 18·7 years; BMI 27·2 ± 4·2 kg/m² and compared with 12 healthy, euthyroid, age-matched controls (age 41·4 ± 19·3; BMI 24·8 ± 4·4 kg/m²) with no history of cardiovascular disease. No interventional measures were instituted.
Measurements  Arterial stiffness was measured using pulse wave analysis at the radial artery. Thyroid function, fasting lipids and glucose were also measured on the same occasion in both patients and controls.
Results  The corrected augmentation index, a surrogate marker of arterial stiffness was significantly higher in patients compared with controls (21·0% ± 14·1% vs. 5·4% ± 18·2%, P  < 0·03). Low density lipoprotein cholesterol (LDL-cholesterol) levels were also significantly elevated in patients compared with controls (3·0 ± 0·6 vs. 2·1 ± 0·5 mmol/l; P  < 0·002).
Conclusion  RTH patients show evidence in this study of increased augmentation index consistent with an increase in arterial stiffness compared with euthyroid controls. They also demonstrate elevated LDL-cholesterol levels. Both these measures may lead to increased cardiovascular risk.     

The United States to Africa lupus prevalence gradient revisited

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that has a significantly higher prevalence, morbidity and mortality in African Americans compared with Americans of European descent. The pathogenesis of lupus is unclear but appears to be a result of environmental factors interacting with a genetically susceptible host. Despite the high disease load of SLE in African Americans, there is the perception that lupus is relatively rare in Africa. This prevalence gradient suggests that comparative studies of related cohorts from the two continents may provide insight into the genetic/environmental interactions that result in the development of lupus. To define if a lupus gradient exists, we began a study of autoimmunity prevalence utilizing two unique cohorts. The first is the Gullah population of the Sea Islands of South Carolina, who are unique in their low genetic admixture and their known ancestral heritage. The second is the population of young women served by the West Africa Fistula Foundation in Bo, Sierra Leone. Anthropologic studies indicate a direct ancestral link between the Gullah population and Sierra Leoneans. Since it is impossible to perform an epidemiologic study of lupus in Sierra Leone at this time, we assessed the prevalence of lupus serum autoantibodies, serologic evidence of specific infections and levels of serum 25-OH vitamin D in young women in the two cohorts who have no known relatives with lupus. Our results indicate similar prevalence of serum antinuclear antibodies in the two cohorts, though there was a significantly increased prevalence of antiphospholipid and anti-Sm antibodies in the Sierra Leone cohort. Seropositivity to common viral infections was significantly higher in women from Sierra Leone, while serum 25-OH vitamin D levels were markedly lower in the Gullah population. These data suggest that the prevalence of autoimmunity is similar in the two populations, but that there are significant environmental differences that may impact progression to autoimmune disease. Further studies comparing these two cohorts is likely to provide important insight into the impact of environmental factors on development of lupus.     

The metabolic syndrome as a link between smoking and cardiovascular disease

Objective:  Smoking is associated with a significant increase in the cardiovascular risk. The possible relationship of smoking with insulin resistance might further enhance the cardiovascular risk of the patients and is therefore of great clinical interest.
Design, Setting and Subjects:  We have retrospectively evaluated data of 3804 non-diabetic men attending a medical outdoor clinic. Clinical [body mass index (BMI), percentage of body fat, waist-to-hip ratio] and laboratory results were compared between smokers (n = 124) and non-smokers (n = 1915) without cardiovascular disease, as well as between smokers (n = 759) and non-smokers (n = 1006) with cardiovascular disease.
Results:  Smokers without clinically manifest cardiovascular disease revealed significantly higher fasting glucose (5.8 ± 0.6 mmol/l) and triglyceride levels (1.8 ± 0.9 mmol/l) than non-smokers (fasting glucose: 5.1 ± 0.7 mmol/l, p < 0.010; triglycerides: 1.5 ± 0.8 mmol/l, p < 0.030). The adverse metabolic profile of smokers was even more pronounced in patients with cardiovascular disease. An age-matched analysis of smokers could demonstrate that cardiovascular patients revealed higher BMI values (27.3 ± 2.4 kg/m²) and a higher percentage of body fat (25.5 ± 5.5%) than those without cardiovascular disease (BMI: 25.7 ± 2.2 kg/m², p < 0.010; percentage of body fat: 23.0 ± 5.5%, p < 0.030).
Conclusion:  In men with and without clinically manifest cardiovasular disease, smoking was associated with a metabolic profile indicating a higher degree of insulin resistance.     

Impact of obesity on coronary artery calcification examined by electron beam computed tomographic scan

Aim:  Obesity is highly associated with cardiovascular disease (CVD). The early and non-invasive diagnosis method for asymptomatic obese is desirable. The aim of this study was to examine the impact of obesity on coronary artery calcification (CAC) by electron beam computed tomographic (EBCT) scan.
Methods:  A total of 465 subjects (i) aged between 40 and 65 years, (ii) being Chinese, (iii) without clinical or historical angiographic obstruction or arrhythmia and (iv) without family history of CVD were enrolled in this study. All the subjects were assigned to one of the EBCT CAC score categories according to the quartiles: quartile 1 (<25%), quartile 2 (25–49%), quartile 3 (50–75%) and quartile 4 (>75%), for further assessment and comparison. The main outcome evaluated is the difference in CAC scores between obese [body mass index (BMI): ≥30 kg/m²] and healthy (BMI: 18.5–25.0 g/m²) BMI groups. The trends of the characteristics in CAC quartile groups and the odds ratios (ORs) were also evaluated.
Results:  The mean of CAC scores between the obese and the healthy BMI groups showed significant difference (p = 0.05). The obese subjects had higher ORs (1.0–5.8 times) than those with BMI < 23 kg/m², and male had higher ORs (1.1–3.6 times) than female, to develop the high CAC score quartile group.
Conclusion:  This study demonstrated that the obese BMI group has a higher mean of CAC scores than the healthy BMI group of middle-aged, asymptomatic, Chinese adults. The obese males have higher risk of developing high CAC scores, which might induce CVD.     

The effect of acarbose on insulin resistance in obese hypertensive subjects with normal glucose tolerance: a randomized controlled study

Aim:  Acarbose, a glucose oxidase inhibitor, delays the absorption of glucose thus reducing post-prandial blood glucose level, haemoglobin A1c (HbA1c) and insulin resistance in patients with diabetes mellitus and in subjects with impaired glucose tolerance. The effect of acarbose in subjects with normal glucose tolerance (NGT) has hitherto not been examined. The aim of the present study was to examine the effect of acarbose in obese hypertensive subjects with NGT.
Methods:  A double-blinded, parallel group study was performed on 56 male subjects with hypertension, body mass index (BMI) 27–35 kg/m², fasting blood glucose ≤ 6 mmol/l and a normal oral glucose tolerance test. Blood pressure, HbA1c, lipid profile and insulin resistance [homeostasis model assessment (HOMA) index] were determined initially and following 24 weeks of acarbose, 150 mg/day or placebo. The primary end point was the change in insulin resistance. Anti-hypertensive treatment and diet were kept constant during the study.
Results:  Insulin resistance decreased in acarbose users but not on placebo. HOMA index declined from 5.36 ± 1.7 to 4.10 ± 1.6 (p = 0.001) on acarbose, the corresponding values on placebo were 5.44 ± 1.9 and 5.53 ± 1.7. A decrease in serum triglyceride values (2.16 ± 0.16 mmol/l to 1.76 ± 0.15 mmol/l, p = 0.02) took place on acarbose with no change on placebo. There was no change in BMI, low-density lipoprotein or high-density lipoprotein values in either group. Blood pressure declined equally in both the groups, probably due to better patient compliance.
Conclusions:  Acarbose may reduce insulin resistance and triglycerides also in obese hypertensive subjects with normal glucose tolerance.     

Effect of simulated altitude during sleep on moderate-severity OSA

Objective:   These studies were conducted to test the hypothesis that isobaric hypoxia would switch OSA to central sleep apnoea (CSA).
Methods:   Five adult men (mean age 54.2 ± 5.5 years, mean BMI 29.9 ± 6.7 kg/m²) with moderate OSA underwent overnight polysomnography at three altitudes. The highest altitude was simulated in a normobaric hypoxic chamber.
Results:   The obstructive respiratory disturbance index fell from 25.5 ± 14.4/h at 60 m to 17.3 ± 9.2/h at 610 m and 0.5 ± 0.7/h at 2750 m ( P  = 0.004 compared with 60 m). The central respiratory disturbance index rose from 0.4 ± 0.5/h at 60 m to 8.1 ± 5.8/h at 610 m and 78.8 ± 29.7/h at 2750 m ( P  < 0.001 compared with 60 m). Mean sleep SaO₂ fell from 94 ± 1% at 60 m to 93 ± 1% at 610 m to 85 ± 4% at 2750 m ( P  < 0.001 compared with 60 m).
Conclusion:   Moderate severity OSA at sea level (60 m) was completely replaced by severe CSA at a simulated altitude of 2750 m. The authors believe that the OSA resolved because of an increased respiratory rate and an increase in upper airway tone, whereas CSA developed because of hypocapnia in non-rapid eye movement sleep.     

Cytidine deaminase genotype and toxicity of cytosine arabinoside therapy in children with acute myeloid leukemia

Cytosine arabinoside (ara-C) is irreversibly deaminated to a non-toxic metabolite by cytidine deaminase (CDA). A common polymorphism, A79C, in the gene encoding cytidine deaminase ( CDA ) changes a lysine residue to glutamine resulting in decreased enzyme activity. CDA A79C genotypes were determined in 457 children with acute myeloid leukaemia (AML) treated on the Children's Cancer Group (CCG) 2941 and 2961 protocols and analyzed the impact of CDA genotype on therapy outcomes. Postinduction treatment-related mortality (TRM) was significantly elevated in children with the CC genotype (5-year TRM 17 ± 13% CC vs. 7 ± 4% AA, 5 ± 4% AC, P  = 0·05). This was more notable in children who received idarubicin, fludarabine, ara-C, and granulocyte colony-stimulating factor (IDA-FLAG; ara-C = 7590 mg/m²) (5-year TRM 24 ± 21% CC vs. 6 ± 6% AA, 6 ± 7% AC, P  = 0·07) as consolidation therapy compared to idarubicin, dexamethasone, cytarabine, thioguanine, etoposide and daunomycin (IDA-DCTER; ara-C = 800 mg/m²) (5-year TRM 15 ± 20% CC vs. 8 ± 6% AA, 4 ± 6% AC; P  = 0·29). Relapse-free survival was non-significantly increased in children with the CC genotype treated with IDA-FLAG (76 ± 20% CC vs. 59 ± 12% AA and 55 ± 14% AC; P  = 0·40). These data indicate that children with a low activity CDA genotype are at increased risk of TRM with ara-C based therapy for AML.     

The prevalence of type II diabetes mellitus in rural urban population over 35 years of age in Lublin region (Eastern Poland)

The prevalence of type 2 diabetes mellitus (DM 2) has increased dramatically in the last decade. Data relating to the number of undetected cases of diabetes are underestimated. The aim of the study was to evaluate the prevalence of DM 2, obesity, hypertension, and lipid disturbances in a representative group of urban and rural population in the Lublin region (Eastern Poland). The study was performed in 1998-2001. A two-layer draw was applied: two groups of 3000 people were drawn from the population of Lublin town and from the rural areas each comprising 100,000 inhabitants. In all subjects physical examination was performed and body weight, height, and blood pressure measurements were obtained. Blood samples were taken from the basilic vein to estimate: blood glucose, lipids and insulin concentration. Venous blood glucose concentration was measured using a Glucotrend glucometer. Oral glucose tolerance test (OGTT) after a 75 g-glucose load was performed in subjects without previously diagnosed diabetes mellitus and when the fasting blood glucose was < 8.0 mmol/l (144 mg/l). The LDL-cholesterol level was calculated according to Friedewald formula. DM 2 was identified according to the WHO criteria from 1985. Obesity and hypertension were diagnosed according to the new WHO criteria (Body Mass Index > or = 30 kg/m2, blood pressure > or = 140/90 mm Hg). 3782 subjects: 1809 in the rural area and 1973 in Lublin town were examined. The response rate among rural and urban population was 60.3% and 65.8% respectively. The prevalence of DM 2 was assessed in 17.6% of rural and in 14.1% of urban population. 75% of diabetics in the rural areas and 56% in the town were the newly diagnosed cases. We found impaired glucose tolerance in 30.3% of rural and in 21.6% of urban population, BMI > or = 30 kg/m2 in 30.8% and 30.1%, hypertension in 69.4% (29.2% newly diagnosed) and 68.6% (27.7% newly diagnosed), hypercholesterolaemia (total cholesterol > or = 5.2 mmol/l (200 mg/dl)) in 66.4% and 60%, hyper-LDL-cholesterolaemia (> or = 3.5 mmol/l (135 mg/dl)) in 57.3% and 52.6%, hypo-HDL--cholesterolaemia in 21.7% and 31.4%, hypertriglyceridemia (> or = 2.3 mmol/l (200 mg/dl)) in 15.1% and 22% respectively. This finding indicates the urgent need for introducing a national program for early diagnosis and prevention of DM 2 and concomitant metabolic disturbances.     

Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation

Background: Obesity and obstructive sleep apnea (OSA) are associated with atrial fibrillation (AF). The effects of a large body mass index (BMI) and OSA on the results of radiofrequency catheter ablation (RFA) of AF are unclear.
Objective: To evaluate the effect of BMI and OSA on the efficacy of RFA for AF.
Methods: RFA was performed in 324 consecutive patients (mean age = 57 ± 11 years) with paroxysmal (234) or chronic (90) AF. OSA was diagnosed by polysomnography in 32 of 324 patients (10%) prior to ablation. Among the 324 patients, 18% had a normal BMI (<25 kg/m²), 39% were overweight (BMI ≥ 25 kg/m² and <30 kg/m²), and 43% were obese (≥30 kg/m²). RFA was performed to eliminate complex fractionated atrial electrograms (CFAE) in the pulmonary vein antrum and left atrium.
Results: At 7 ± 4 months after a single ablation procedure, 63% of patients without OSA and 41% with OSA were free from recurrent AF without antiarrhythmic drug therapy (P = 0.02). Multivariate analysis including variables of age, gender, type and duration of AF, OSA, BMI, left atrial size, ejection fraction, and hypertension demonstrated that OSA was the strongest predictor of recurrent AF (OR = 3.04, 95% CI: 1.11–8.32, P = 0.03). There was no association between BMI and freedom from recurrent AF. A serious complication occurred in 3 of 324 patients, with no relationship to BMI.
Conclusions: OSA is a predictor of recurrent AF after RFA independent of its association with BMI and left atrial size. Obesity does not appear to affect outcomes after radiofrequency catheter ablation of AF.     

Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh.

AIMS: To describe differences in prevalence of Type 2 diabetes mellitus with its associated risk factors between rural and urban populations in Bangladesh. Diagnostic criteria [fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT)] were compared and reviewed for both populations. METHODS: A total of 1555 subjects from urban and 4757 from rural communities (age > or = 20 years) with similar cultural and ethnic backgrounds were randomly selected in a cross-sectional survey. FBG values were determined from all and 2-h post-glucose capillary blood samples were determined after a 75-g oral glucose load for a selected number (urban 476, rural 1046). RESULTS: A higher prevalence of diabetes was found in urban (8.1%) compared with rural populations (2.3%). Age, sex and waist-to-hip ratio for men were significant risk factors for both urban and rural subjects following fasting and 2-h post-glucose values adjusted for a number of confounding variables. Poor agreement was observed between FBG and OGTT for both urban (kappa 0.41) and rural (kappa 0.40) areas. CONCLUSIONS: A higher prevalence of diabetes mellitus (DM) in the urban population was observed compared with rural subjects despite similar body mass indexes (BMI). Differences in obesity, waist/hip ratio or hypertension failed to explain the increasing occurrence of T2DM in the urban population.