Body mass index (BMI) and waist circumference (WC) as screening tools for cardiovascular risk factors in Guadeloupean women

Hypertension, dyslipidemia and type 2 diabetes, important cardiovascular risk factors, are strongly linked to obesity. Body mass index (BMI) and waist circumference (WC) are measures of obesity that can be useful in identifying individuals with these risk factors. We assessed which of the two measures is more informative at the population level. The study population included 5,149 consecutive women aged 18 to 74 recruited in an Health Center of Guadeloupe (FWI) in 1999. The areas under the ROC curves of BMI and WC and their 95% CI were computed and compared. Logistic regression analysis of BMI and WC and the areas under the ROC curves in two separate age groups (18-39 years and 40-74 years) showed that age modifies the discriminant ability of these parameters in identifying the CVD risk factors. Sensitivity equalled specificity at levels between 52-70% for BMI and 55-80% for WC. ROC areas for identifying each risk factors by BMI varied from 0.52 to 0.84 and by WC from 0.55 to 0.88. For the identifying of women with at least one CVD risk factor, in the whole population, the areas under the curves for BMI and WC (respectively, 0.71; 95% CI: 0.69-0.73 and 0.76; 95% CI: 0.74-0.78) were both significantly greater than 0.5. The difference between these correlated areas was 0.04, 95% CI [-0.05, -0.03]. The lowest values of the areas were noted in detecting women with dyslipidemia and the highest in detecting those with type 2 diabetes. Waist circumference, a practical tool that had a higher discriminant ability than BMI in identifying presence or absence of all these risk factors, appears as the best screening tool in this population.     

Statistical classification strategy for proton magnetic resonance spectra of soft tissue sarcoma: an exploratory study with potential clinical utility

Purpose: Histological grading is currently one of the best predictors of tumor behavior and outcome in soft tissue sarcoma. However, occasionally there is significant disagreement even among expert pathologists. An alternative method that gives more reliable and non-subjective diagnostic information is needed. The potential use of proton magnetic resonance spectroscopy in combination with an appropriate statistical classification strategy was tested here in differentiating normal mesenchymal tissue from soft tissue sarcoma.Methods: Fifty-four normal and soft tissue sarcoma specimens of various histological types were obtained from 15 patients. One-dimensional proton magnetic resonance spectra were acquired at 360 MHz. Spectral data were analyzed by using both the conventional peak area ratios and a specific statistical classification strategy.Results: The statistical classification strategy gave much better results than the conventional analysis. The overall classification accuracy (based on the histopathology of the MRS specimens) in differentiating normal mesenchymal from soft tissue sarcoma was 93%, with a sensitivity of 100% and specificity of 88%.The results in the test set were 83, 92 and 76%, respectively. Our optimal region selection algorithm identified six spectral regions with discriminating potential, including those assigned to choline, creatine, glutamine, glutamic acid and lipid.Conclusion: Proton magnetic resonance spectroscopy combined with a statistical classification strategy gave good results in differentiating normal mesenchymal tissue from soft tissue sarcoma specimens ex vivo. Such an approach may also differentiate benign tumors from malignant ones and this will be explored in future studies.     

An ex vivo study exploring the diagnostic potential of 1H magnetic resonance spectroscopy in squamous cell carcinoma of the head and neck region

BACKGROUND: Definitive diagnosis of head and neck cancer is generally made by histopathologic evaluation. Management and prognosis largely depend on accurate and timely diagnosis. We have explored the use of (1)H magnetic resonance spectroscopy in search of a better or complementary diagnostic technique. METHODS: Tumor and adjacent normal tissue specimens (n = 135) from untreated head and neck cancer patients (n = 40) were obtained and subjected to spectroscopic evaluation followed by histopathologic analysis. Data were partitioned into training and test sets and subjected to multivariate analysis. RESULTS: The resonances from taurine, choline, glutamic acid, lactic acid, and lipid were found to have diagnostic potential by our optimal region selection algorithm. Multivariate analysis of the spectral data differentiated between normal and malignant tissues, with an overall accuracy of 92.6% (training set, 97.3%; test set, 87.3%), an overall sensitivity of 93% (test set, 90%), and an overall specificity of 92% (test set, 82.6%). CONCLUSIONS: (1)H magnetic resonance spectroscopy combined with multivariate methods of analysis can distinguish between normal and malignant squamous cell tissue, and this may lead to the development of an objective and noninvasive diagnostic procedure.     

Response surface methodology for the development of self-nanoemulsified drug delivery system (SNEDDS) of all-trans-retinol acetate

The purpose was to prepare, characterize, and optimize a self-nanoemulsified drug delivery system (SNEDDS) of a model lipophilic compound, all-trans-retinol acetate. As part of the optimization process, the main effects, interaction effects, and quadratic effects of the formulation ingredients were investigated. METHOD: A three-factor, three-level Box-Behnken design was used to explore the quadratic response surfaces and construct a second-order polynomial model in the form: Y = A + A1X1 + A2X2+ A3X3 + A4X1X2 + A5X2X3 + A6X1X3+ A7X1(2) + A8X2(2) + A9X3(2) + E. Amount of added oil (X1), surfactant (X2), and cosurfactant (X3) were selected as the factors. Particle size (Y1), turbidity (Y2), and cumulative amount of the active ingredient emulsified after 10 (Y3) and 30 (Y4) min were the observed variables. Response surface plots were used to demonstrate the effect of factors (X1), (X2), and (X3) on the response (Y4). Amount of added soybean oil (X1), Cremophor EL (X2), and Capmul MCM-C8 (X3) showed a significant effect on the emulsification rates, as well as on the physical properties of the resultant emulsion (particle size and turbidity). Observed and predicted values of Y4 obtained from the constructed equations were in close agreement. Response surface methodology was then used to predict the levels of factors X1, X2, and X3 under the constrained variables for an optimum response. Applied constraints were 0 < Y1 < 0.5, 1 < Y2 < 20, 60 < Y3 < 80, and 90 < Y4 < 100. The predicted values were 0.0704 microm for particle size (Y1), 18.95 NTU for turbidity (Y2), 88.88% for drug release after 10 min (Y3), and 110.7% drug release after 30 min (Y4). Two new formulations were prepared according to the predicted levels. The observed and predicted values were in close agreement.     

Differences in food intake and exercise by smoking status in adolescents

BACKGROUND: Smoking, diet, and lack of exercise are the top preventable causes of death in the United States. Some 23% of high school students currently smoke and many teens do not meet Healthy People 2010 standards for healthy eating or physical activity. This study examined the relationship between smoking and the consumption of fruit, vegetables, milk/dairy products and the frequency of exercise in 10,635 Virginia youth. METHODS: Survey data were collected from middle school (MS; n = 8022) and high school (HS; n = 2613) adolescents participating in youth tobacco prevention/cessation programs. Data were analyzed using chi-square bivariate tests and multivariate regression models. RESULTS: Smokers were significantly less likely than nonsmokers to exercise > or = 3x week and to consume > or = 1 serving/day of vegetables or milk/dairy products. This was more evident in high school than middle school students and in females compared to males. In both HS and MS, a dose-response relationship was detected with higher level smoking associated with lower frequency of eating specified food and exercise. CONCLUSIONS: Smoking is associated with compromised intake of healthy food and exercise. To decrease incident cases of chronic disease later in life, new tailored, innovative interventions are needed that address multiple health behaviors in youth.     

Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease

Context  Recent reports suggest an increasing occurrence and severity of Clostridium difficile–associated disease. We assessed whether the use of gastric acid–suppressive agents is associated with an increased risk in the community. Objective  To determine whether the use of gastric acid–suppressive agents increases the risk of C difficile–associated disease in a community population. Design, Setting, and Patients  We conducted 2 population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, we identified all 1672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice. Each case was matched to 10 controls on calendar time and the general practice. In the second study, a subset of these cases defined as community-acquired, that is, not hospitalized in the prior year, were matched on practice and age with controls also not hospitalized in the prior year. Main Outcome Measures  The incidence of C difficile and risk associated with gastric acid–suppressive agent use. Results  The incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100 000 in 1994 to 22 per 100 000 in 2004. The adjusted rate ratio of C difficile–associated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H₂-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5). Conclusions  The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.      

Stroke in patients with diabetes and hypertension

Stroke is major public health problem leading to increased morbidity and mortality. Modifiable risk factors for stroke include hypertension, diabetes, atrial fibrillation, dyslipidemia, smoking, and alcohol abuse. Among these risk factors, diabetes and hypertension are rapidly growing epidemics leading to a substantial increase in cardiovascular disease and stroke. In this review, the authors discuss the risk factors for stroke with emphasis on the diabetic and hypertensive population, highlighting the interventions that have been shown to decrease stroke risk in this patient population.