Corrected transposition of the great vessels: a vectorcardiographic study.

The vectorcardiograms (VCGs) of two groups of patients with corrected transposition of the great vessels (CTGV) were studied; the first, group A, included 17 patients with CTGV in "situs solitus,", characterized by leftward orientation of the cardiac apex; the second group, group B, with three patients, presented CTGV in "situs solitus" and apex to the right. All cases had one or more associated defects: ventricular septal defect, atrial septal defect, pulmonic stenosis or tricuspid insufficiency.     

Mechanism of action of phenethylbiguanide (phenformin) in man IV. Effect of phenethylbiguanide (PBG) on glucose tolerance and lactate dynamics in obese nondiabetic and chemical diabetic subjects

The effects of long-term administration of phenethyl-biguanide hydrochloride (PBG) on glucose tolerance (oral and IV) and lactate dynamics were studied in obese nondiabetic and chemical diabetic subjects. In the obese nondiabetic subjects, parameters of glucose tolerance—glucose curve areas and glucose disappearance rates (K_g)—were not significantly altered by PBG. However, significant elevations of immunoreactive insulin (IRI) in the oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT) were observed while being treated with PBG, suggesting some degree of “insulin resistance”. Means of blood lactate levels during the OGTT were similar before and while on PBG treatment. Lactate dynamics revealed an increased lactate pool distributed in a larger volume, without significant changes in fasting blood lactate. In the obese chemical diabetic patients, glucose curve areas during the OGTT were corrected in the PBG period, despite the presence of decreased insulin responses to glucose. In the IVGTT, similar glucose curve areas and K_g values were shown in the presence of reduced insulin responses. These changes suggest some degree of PBG-induced facilitation of glucose entry into the cell in obese chemical diabetics. Blood lactate levels in the OGTT were higher at all times during PBG treatment, including fasting values. Lactate dynamics revealed that PBG increased the endogenous production rate of lactate, with expansion of the total lactate pool and no variation in the space of distribution. Plasma lactate concentrations increased significantly. These results show different effects of PBG in obese nondiabetics and obese chemical diabetics, in relation to glucose and lactate dynamics. Furthermore it seems that its effects on lactate dynamics are only exerted in the basal metabolic state of the patients.     

Effects of insulin and glucagon on plasma glucose levels and glycogen content in organs of the freshwater teleost Pimelodus maculatus

Mammalian insulin (350 IU/kg) and glucagon (2.5 mg/kg) were injected intraperitoneally into Pimelodus maculatus, a South American teleost. Extent of carbohydrate regulation was estimated through determination of plasma glucose levels, liver-somatic index, and liver and muscle glycogen contents. The effects of insulin administration, examined 6, 12, 24, 48, and 72 hr after injection, were manifested as a depletion of liver glycogen content after 12 hr and severe decrease in plasma glucose content after 24 hr; insulin had no effect on muscle glycogen or liver-somatic index. The effects of glucagon administration, examined 5, 15, 30, 90, and 360 min after injection, were a small increase in liver glycogen content after 15 min, and hyperglycemia, apparent after 30 min. Glucagon did not affect muscle glycogen or liver-somatic index. Control animals were injected intraperitoneally with saline solution. These results suggest that insulin and glucagon regulate the carbohydrate metabolism of P. maculatus by hormonal mechanisms similar to those operating in other teleost species and in mammals.     

Cost-utility analysis of genetic polymorphism universal screening in colorectal cancer prevention by detection of high-risk individuals

BackgroundIn the past 15 years numerous studies have been published on the involvement of low-penetrance susceptibility genes on the risk for developing colorectal cancer (CRC).AimTo perform an economic analysis of blood genetic testing in CRC screening in a population-based nationwide setting using polymorphisms in prostaglandin E₂ pathway genes as proof of concept.MethodsA cost-utility analysis was performed from a societal perspective in Portugal comparing two strategies: blood genetic testing by the age of 40 versus no genetic screening under different assumptions of the cost of genetic testing (€10 and €30) and expected risk (1.5 to 5-fold). The adopted threshold was set at €44,870 (USD 50,000). The primary outcome was the incremental cost-effectiveness ratio (ICER) for a base case scenario.ResultsPolymorphism genotyping provided cost-utility only under the assumption of a 5-fold increased risk in the general population, providing ICERs of €44,356 and €30,389 for €30 and €10 tests, respectively.ConclusionBlood genetic screening for colorectal cancer has cost-utility only under specific assumptions of increased CRC risk and conservative cost estimates. Future studies should focus on defining genetic profiles because single-gene approaches are very unlikely to be cost-effective considering their modest predictive value.     

Prognostic Effect of Renal Function in Ambulatory Patients With Heart Failure and Reduced Ejection Fraction: The Kidney Is a Marker of Cardiac Function

Background

Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased mortality. The impact of temporal evolution of kidney function in HF prognosis is largely unknown. We evaluated the effect of renal function over time in all-cause mortality among ambulatory patients with HF.