Obesity and left ventricular dilatation in young adulthood: the Bogalusa Heart Study

Background:

Cardiac enlargement is an important predictor of adverse cardiovascular (CV) events. Left ventricular (LV) dilatation is a precursor both of LV dysfunction and clinical heart failure. The present study examines risk factors for LV dilatation among 832 young adults (341 male, 491 female) who participated in the Bogalusa Heart Study.

Hypothesis:

A unique set of risk factors predicts LV dilatation among young adults.

Methods:

Standard ventricular dimensions were determined by M‐mode echocardiography and indexed to height using a standard method. LV dilatation was considered as the top 20th percentile of LV end‐diastolic dimension indexed to height. Logistic regression models were used, stratified by race and sex, to assess the relationship of CV risk factors with quintile of LV end‐diastolic dimension indexed to height.

Results:

The mean age (standard deviation) of men and women in the population was 36.4 years (3.9 years) and 35.9 years (4.6 years), respectively. In sex‐specific models adjusted for age, race, systolic and diastolic blood pressure, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, triglycerides, and glycosylated hemoglobin, body mass index (BMI) was a significant predictor of LV dilatation in both men and women. The odds ratio (95% confidence interval) for a 1‐unit change in BMI was 1.12 (1.02–1.19) in men and 1.09 (1.05–1.13) in women. Among men, triglyceride level was also significantly associated with LV dilatation (P = 0.03), whereas among women there was no such association.

Conclusions:

Our findings indicate that obesity is the most consistent predictor of LV dilatation in both men and women, whereas triglyceride level was a significant predictor among men only. © 2011 Wiley Periodicals, Inc. The Bogalusa Heart Study is supported by a grant from the National Institute of Aging (5R01AG016592). Dr. Bazzano was supported by grant no. K08HL091108 from the National Heart Lung and Blood Institute (NHLBI). The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Heritage of army audiology and the road ahead: the Army Hearing Program

Noise-induced hearing loss has been documented as early as the 16th century, when a French surgeon, Ambroise Paré, wrote of the treatment of injuries sustained by firearms and described acoustic trauma in great detail. Even so, the protection of hearing would not be addressed for three more centuries, when the jet engine was invented and resulted in a long overdue whirlwind of policy development addressing the prevention of hearing loss. We present a synopsis of hearing loss prevention in the US Army and describe the current Army Hearing Program, which aims to prevent noise-induced hearing loss in soldiers and to ensure their maximum combat effectiveness.     

iRhom2 regulates CSF1R cell surface expression and non‐steady state myelopoiesis in mice

CSF1R (colony stimulating factor 1 receptor) is the main receptor for CSF1 and has crucial roles in regulating myelopoeisis. CSF1R can be proteolytically released from the cell surface by ADAM17 (A disintegrin and metalloprotease 17). Here, we identified CSF1R as a major substrate of ADAM17 in an unbiased degradomics screen. We explored the impact of CSF1R shedding by ADAM17 and its upstream regulator, inactive rhomboid protein 2 (iRhom2, gene name Rhbdf2), on homeostatic development of mouse myeloid cells. In iRhom2‐/‐ mice, we found constitutive accumulation of membrane‐bound CSF1R on myeloid cells at steady state, although cell numbers of these populations were not altered. However, in the context of mixed bone marrow (BM) chimera, under competitive pressure, iRhom2‐/‐ BM progenitor‐derived monocytes, tissue macrophages and lung DCs showed a repopulation advantage over those derived from wild‐type (WT) BM progenitors, suggesting enhanced CSF1R signaling in the absence of iRhom2. In vitro experiments indicate that iRhom2‐/‐ Lin^?SCA‐1⁺c‐Kit⁺ (LSKs) cells, but not granulocyte‐macrophage progenitors (GMPs), had faster growth rates than WT cells in response to CSF1. Our results shed light on an important role of iRhom2/ADAM17 pathway in regulation of CSF1R shedding and repopulation of monocytes, macrophages and DCs.     

The association between T-stage and clinical nodal metastasis In HPV-positive oropharyngeal cancer

Purpose

To evaluate the association between T-stage and primary tumor subsite with clinical nodal metastasis in HPV-positive oropharyngeal squamous cell carcinomas.

Study Design

Retrospective medical record review.

Materials and Methods

A retrospective analysis of all previously untreated patients with HPV-positive oropharyngeal squamous cell carcinoma evaluated by the senior author in a tertiary-care center over a 5-year period was performed. Medical records were evaluated for HPV status, clinical T-stage, clinical nodal stage, and anatomic location of primary oropharyngeal subsite.

Results

83% (59/71) of patients presented with clinical nodal disease. T-stage was not associated with the absence of regional disease (cN0) in tonsillar complex or base of tongue cancers. However, early T1/T2 tonsillar complex cancers were less likely to present with cN2c disease compared to T3/T4 lesions (0% vs. 18–33%, p = 0.03). Further, base of tongue cancers were more likely to present with cN2c disease compared to tonsillar complex tumors (35% vs. 7%, p = 0.01).

Conclusion

In HPV-positive tonsillar complex cancers, T-stage does not appear to predict the presence of clinical nodal metastasis (N0 vs. N1-N3), but may predict the extent of metastasis when present. This association does not appear to affect base of tongue cancers. Further, base of tongue cancers have a greater incidence of cN2c disease compared to tonsillar complex cancers.     

Parity and breastfeeding among African-American women: differential effects on breast cancer risk by estrogen receptor status in the Women’s Circle of Health Study

Purpose

It has long been held that parity reduces risk of breast cancer. However, accumulating evidence indicates that the effects of parity, as well as breastfeeding, may vary according to estrogen receptor (ER) status. We evaluated these associations in a case–control study among African-American women in New York City and New Jersey.

Methods

In the Women’s Circle of Health Study, including 786 African-American women with breast cancer and 1,015 controls, data on reproductive histories were collected from in-person interviews, with tumor characteristics abstracted from pathology reports. We calculated number of live births and months breastfeeding for each child, and examined each in relation to breast cancer by ER status, and for triple-negative (TN) breast cancer.

Results

Although associations were not statistically significant, having children was associated with reduced risk of ER+ breast cancer [odds ratio (OR) 0.82, 95 % confidence interval (CI) 0.58–1.16], but increased risk of ER? tumors, with associations most pronounced for TN breast cancer (OR 1.81, 95 % CI 0.93–3.51). Breastfeeding gave no additional benefit for ER+ cancer, but reduced the risk of ER? disease associated with parity.

Conclusions

Accumulating data from a number of studies, as well as our own in African-American women, indicate that the effects of parity and breastfeeding differ by ER status. African-American women are more likely to have children and not to breastfeed, and to have ER? and TN breast cancer. It is possible that breastfeeding in this population could reduce risk of more aggressive breast cancers.     

Subglottic laryngeal closure for aspiration

Aspiration may be life threatening, particularly in those patients with severe central neurological disease. From such a group of patients, several were identified who had severe laryngeal dysfunction and aspiration. The majority of patients in this subgroup existed in a neurologically vegetative state. In an attempt to reduce the degree of aspiration they experienced, the procedure of subglottic laryngeal closure was performed. Essentially, the operation is designed to isolate the tracheal airway from the incompetent larynx. The aim is to protect the lower airway from pharyngeal contamination. In all 5 patients there was a marked improvement in general and pulmonary health.     

Implementing marketing strategy (Part four)

Every organization must monitor and evaluate the performance of its marketing strategies. The health care marketer must continually develop effective measures related to outcomes so that marketing efforts can be justified and garnish the support and resources they deserve. A major task for the marketing executive for the next decade is to develop marketing strategies and prove that those strategies are being met and that they help the health care organization carry out its objective to meet its mission.