Knowledge and awareness of peripheral vascular disease are poor among women at risk for cardiovascular disease

OBJECTIVE: Peripheral vascular disease (PVD), a manifestation of systemic atherosclerosis, is an independent risk factor for cardiovascular (CV) morbidity and mortality. PVD research has traditionally focused on male patients; thus, there is a lack of current studies focusing specifically on women. In a cross-sectional study, we assessed the prevalence of PVD and associated atherosclerotic risk factors in ambulatory women veterans as well as knowledge and awareness of PVD and its consequences. MATERIALS AND METHODS: We screened 162 ambulatory women veterans aged 40 to 85 who were enrolled for outpatient care at an urban, tertiary care, teaching hospital. Of 207 women who responded to advertisements or mailings about the study, 78.3% met eligibility criteria and gave informed consent to participate. The participants (N = 162, mean age 54.8 +/- 9.3 years) were evaluated via chart review and noninvasive screening procedures (ankle-brachial index [ABI]; carotid artery intimal-medial thickness [IMT]). PVD was defined by having an ABI 1.0 mm, documented PVD, or previous leg revascularization. CV risk levels were determined using a modification of the Framingham risk level score: low risk, +0-1 risk factor; moderate risk, +2 risk factors; and high risk, >or=2 risk factors. Women's knowledge and awareness were assessed with a psychometrically sound survey (average subscale reliability: 0.942) about risk factors, symptoms, and health consequences associated with PVD. RESULTS: Of 162 patients, 66.2% were white and 84.2% had at least some college education. An ABI 1.0 mm was detected in 21.1%, while 1.2% had a prior diagnosis of PVD and 1.9% had previous leg revascularization. Risk factor stratification was as follows: low risk in 32.1%, moderate risk in 20.4%, and high risk in 47.5% of patients. Knowledge and awareness scores (% correct) for PVD were low regardless of CV risk factor group: low-risk average score was 45.7%; moderate risk, 42.1%; and high risk, 46.9% (F = 0.431, P = 0.650). Likewise, low scores for knowledge of CV risk factors and consequences were found in all CV risk factor groups: low-risk average score was 53.6%; moderate risk, 53.8%; and high risk, 54.4% (F = .013, P = 0.987). More than 68% of the women reported they had never discussed PVD or risk reduction with their physician, yet more than 44% believed they were at an increased risk for PVD. CONCLUSIONS: Despite the presence of multiple PVD risk factors, women in this study had low levels of knowledge and awareness about vascular diseases. Future work is needed to develop and disseminate information about PVD in women and its role in women's CV health. Improving education about the significance of PVD will allow women and their physicians to assess risk factors and implement preventive measures.     

Prolonged treatment of genetically obese mice with conjugated linoleic acid improves glucose tolerance and lowers plasma insulin concentration: possible involvement of PPAR activation

Background

Studies in rodents and some studies in humans have shown that conjugated linoleic acid (CLA), especially its trans -10, cis -12 isomer, reduces body fat content. However, some but not all studies in mice and humans (though none in rats) have found that CLA promotes insulin resistance. The molecular mechanisms responsible for these effects are unclear, and there are conflicting reports on the effects of CLA on peroxisomal proliferator-activated receptor-γ (PPARγ) activation and expression. We have conducted three experiments with CLA in obese mice over three weeks, and one over eleven weeks. We have also investigated the effects of CLA isomers in PPARγ and PPARα reporter gene assays.

Results

Inclusion of CLA or CLA enriched with its trans -10, cis -12 isomer in the diet of female genetically obese (lep ^ob /lep ^ob ) mice for up to eleven weeks reduced body weight gain and white fat pad weight. After two weeks, in contrast to beneficial effects obtained with the PPARγ agonist rosiglitazone, CLA or CLA enriched with its trans -10, cis -12 isomer raised fasting blood glucose and plasma insulin concentrations, and exacerbated glucose tolerance. After 10 weeks, however, CLA had beneficial effects on glucose and insulin concentrations. At this time, CLA had no effect on the plasma TNFα concentration, but it markedly reduced the plasma adiponectin concentration. CLA and CLA enriched with either isomer raised the plasma triglyceride concentration during the first three weeks, but not subsequently. CLA enriched with its trans -10, cis -12 isomer, but not with its cis -9, trans -11 isomer, stimulated PPARγ-mediated reporter gene activity; both isomers stimulated PPARα-mediated reporter gene activity.

Conclusions

CLA initially decreased but subsequently increased insulin sensitivity in lep ^ob /lep ^ob mice. Activation of both PPARγ and PPARα may contribute to the improvement in insulin sensitivity. In the short term, however, another mechanism, activated primarily by trans -10, cis -12-CLA, which probably leads to reduced adipocyte number and consequently reduced plasma adiponectin concentration, may decrease insulin sensitivity.     

PTEN抑癌基因在乳腺癌组织中的表达及其与乳腺癌微小转移灶的关系

目的:研究PTEN抑癌基因在乳腺癌组织中的表达,探讨其与乳腺癌病人的外周血、骨髓及前哨淋巴结微小转移灶之间的关系。方法:选择53例乳腺癌病人的组织标本,用免疫组织化学方法检测原发肿瘤PTEN蛋白的表达;用定量RT鄄PCR法测定原发肿瘤PTENmRNA的表达。以免疫细胞化学法检测外周血和骨髓中的微小转移灶;HE染色和免疫组织化学法检测前哨淋巴结中的微小转移灶。结果:外周血、骨髓及前哨淋巴结中微小转移灶的检出率分别是24.5%,56.6%,26.4%和41.5%。乳腺癌组织中PTEN蛋白表达呈丢失者占35.8%,后者与外周血和骨髓微小转移灶间无显著关系,而与前哨淋巴结中的微小转移密切相关(P≤0.001)。PTENmRNA的表达与外周血、骨髓及前哨淋巴结中的微小转移灶之间均无显著相关性。结论:乳腺癌组织中PTEN蛋白表达的丢失与前哨淋巴结中的微小转移有密切关系,可作为预测其早期转移的重要指标。     

急危重病人血流动力学最佳化状态治疗研究的Meta分析

目的　探讨有关急危重病人血流动力学状态达到最佳化治疗研究中肺动脉导管 (Swan -Ganz)与复苏治疗的关系 ,评估生理、临床、治疗等方面因素对复苏治疗效果的影响。方法　从MEDLINE(英文医学文献资料网库 )中搜集所有与Swan -Ganz和血流动力学状态有关的 71篇研究文献。按照限定条件进行筛选 :①病人类型 :急性病 ,高危外科手术病人 ,创伤 ;②达到血流动力学指标正常值或超常值标准 ;③控制组死亡率 >2 0 % (危重组 )或 <15 % (一般组 ) ;④治疗后达到血流动力学指标的早晚 ;其中 2 1项研究接受Meta分析。结果　在危重组 ,早期达到血流动力学超常值治疗 ,2 1项研究中的 7项显示在控制组与治疗组之间死亡率有显著性的差别 (P <0 0 5 ) ;而晚期达到血流动力学超常值治疗的 6项研究 ,两组之间死亡率无显著性的差别 (P >0 0 5 )。在一般组 ,达到血流动力学正常值治疗的 5项研究和超常值治疗的 3项研究显示 ,控制组与治疗组之间死亡率无显著性的差别。结论　经Swan -Ganz引导早期达到血流动力学超常值治疗 ,能降低重病组的死亡率。     

Patient preference and willingness to pay for transient elastography versus liver biopsy: A perspective from British Columbia

BACKGROUND:

The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.

OBJECTIVE:

To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.

METHODS:

Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.

RESULTS:

The overall response rate was 76%. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2% were male, 54.7% were Caucasian, 38.2% had hepatitis C and 26.3% had an annual household income >$75,000. Overall, 95.4% of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1% versus 7.8% for LB), no discomfort after (96.2% versus 14.6% LB) and no feelings of anxiety after FS explanation (78.2% versus 12.7% LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2% versus 48.3% LB) and short wait for the test result (95.5% versus 30.2% LB). Most (75.3%) respondents were willing to self-pay for FS, with 26.3% willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95% CI 0.07 to 0.53]).

CONCLUSIONS:

FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.     

T-cell receptor gene rearrangement in T-cell large granular leukocyte leukemia: preferential V alpha but diverse J alpha usage in one of five patients

T-gamma lymphoproliferative disease (T-gamma LPD) is a chronic disorder of mature T cells that is associated with neutropenia and autoimmune phenomena. Although the progression of the lymphoproliferation is indolent, it is often associated with a monoclonal proliferation of T- cell-type large granular lymphocytes (LGL) that manifest multiple in vitro suppressor and cytotoxic activities. We considered the possibility that the granulocytopenia or anemia might represent an autoimmune disorder mediated by the monoclonal LGL via T-cell receptor (TCR) recognition of an antigen involved in hematopoiesis. Therefore, in an effort to characterize the usage of the TCR alpha- and beta-chain genes in patients with T-gamma LPD, we cloned and sequenced TCR alpha- and beta-chain mRNAs derived from the T-cell type LGL of five patients. The five patients studied did not use a common V alpha nor a common J alpha segment. However, an unusual finding was observed in one of the patients where the occurrence of a single variable-diversity-junctional (VDJ) rearrangement of the beta chain confirmed the monoclonal origin of the LGL proliferation. In accord with this evidence for monoclonality, many of the cells studied used a common V alpha (V alpha 19.1). In contrast to this common V alpha usage, there was a marked diversity of the J alpha segments and N-region addition that were associated with the V alpha 19.1 segment. This pattern of common V alpha usage associated with different N and J alpha segments suggests an immune-mediated selection process affecting the TCR alpha chain occurring after the transformation event that established the clone. We suggest that the T-cell-type LGL malignant clone might have developed autoreactivity conferred by the selected TCR alpha chain and that this autoreactivity might be implicated in this patient's anemia.