Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women

OBJECTIVE: To assess the association between endogenous sex hormones and risk factors for atherosclerosis in healthy postmenopausal women. DESIGN: Cross-sectional study in a university menopause clinic. METHODS: Serum sex hormones and lipid-lipoprotein profile, arterial pressure, homocysteine and insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR), were assessed in 598 healthy postmenopausal women not on hormone therapy. RESULTS: Compared with women in the lowest testosterone quartile (Q), women in the highest testosterone quartile had higher total cholesterol (Q1: 225.2 +/- 41.3 vs Q4: 246.2 +/- 38.4 mg/dl, P < 0.01), low-density lipoprotein (LDL)-cholesterol (Q1: 146.9 +/- 37.2 vs Q4: 171.8 +/- 35.3 mg/dl, P < 0.001), atherogenic index of plasma (AIP) (Q1: -0.224 +/- 0.238 vs Q4: -0.087 +/- 0.254, P < 0.01), apolipoprotein B (ApoB) (Q1: 100.7 +/- 23.1 vs Q4: 113.9 +/- 23.8 mg/dl, P < 0.001) and higher high-density lipoprotein (HDL)-cholesterol (Q1: 60.7 +/- 14.5 vs Q4: 52.9 +/- 13.0 mg/dl, P < 0.01). Accordingly, women in the highest free androgen index (FAI) quartile had higher AIP (Q1: -0.232 +/- 0.254 vs Q4: -0.078 +/- 0.243, P < 0.001) and ApoB (Q1: 102.4 +/- 25.5 vs Q4: 114.2 +/- 25.8 mg/dl, P < 0.01) and lower HDL-cholesterol (Q1: 62.0 +/- 15.7 vs Q4: 51.9 +/- 11.6 mg/dl, P < 0.001) and apolipoprotein A (Q1: 159.6 +/- 25.6 vs Q4: 147.9 +/- 24.1 mg/dl, P < 0.01) compared with women in the lowest FAI quartile. These differences remained significant after adjustment for age, body mass index (BMI), insulin resistance and social habits. The free estrogen index (FEI) exhibited similar associations to the FAI. HOMA-IR showed an independent positive association with total testosterone (Q1: 2.00 +/- 1.36 vs Q4: 2.66 +/- 1.60, P < 0.01), FAI (Q1: 1.70 +/- 1.12 vs Q4: 3.04 +/- 1.66, P < 0.001) and FEI (Q1: 1.70 +/- 0.91 vs Q4: 3.08 +/- 1.77, P < 0.001). CONCLUSIONS: Increased androgenicity in healthy postmenopausal women is associated with an unfavorable cardiovascular risk profile. High endogenous estradiol is related to a pro-atherogenic lipid profile, an association which may, in part, be mediated by insulin resistance.     

Diverse associations of microalbuminuria with C-reactive protein, interleukin-18 and soluble CD 40 ligand in male essential hypertensive subjects

BACKGROUND: Microalbuminuria (MA) and low-grade inflammation constitute emerging markers of subclinical atherosclerosis. We investigated whether urinary albumin excretion, expressed as the albumin-to-creatinine ratio (ACR), is associated with high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-18, and soluble CD40 ligand (sCD40L), in hypertensive subjects. METHODS: The study population consisted of 108 nondiabetic male patients with newly diagnosed untreated stage I to II essential hypertension (aged 44.6 years, office blood pressure [BP] 148/95 mm Hg). According to ACR values determined as the average of two nonconsecutive overnight spot urine samples, subjects were divided into microalbuminurics (n = 28) (mean ACR = 30 to 300 mg/g) and normoalbuminurics (n = 80) (mean ACR <30 mg/g). RESULTS: Although microalbuminurics as compared to normoalbuminuric hypertensives had greater hs-CRP levels (2.55 +/- 1.18 v 1.45 +/- 0.52 mg/L, P < .0001), independently of confounding factors, these two groups did not differ regarding IL-18 and sCD40L values (P = not significant [NS] for both cases). In the entire population, ACR exhibited a positive correlation with hs-CRP (r = 0.623, P < .0001), whereas there was no association with both IL-18 and sCD40L (P = NS for both cases). When multiple linear regression analysis was performed, it was revealed that age, body mass index, office systolic BP, total cholesterol, and hs-CRP levels were significant independent predictors of the ACR (P < .05). CONCLUSIONS: In essential hypertensive subjects, MA is accompanied by elevated hs-CRP levels, but not by augmented IL-18 and sCD40L concentrations, suggesting activation of different inflammatory pathways in the progression of renal and cardiovascular atherosclerotic disease. The pathophysiologic mechanisms of these associations remain to be further elucidated in future studies.     

Acute myocardial infarction with normal coronary arteries in a patient with Hodgkin's disease: a late complication of irradiation and chemotherapy

We describe the case of a 31-year-old man who experienced an acute myocardial infarction 16 years after undergoing radiation and vinca alkaloid therapy for Hodgkin's disease. Even though coronary artery disease is a well-established complication after mediastinal radiation therapy, this adult patient had normal coronary angiographic results, with no traditional risk factors for coronary artery disease, and no hematologic or other abnormality associated with hypercoagulability.     

The interplay between haemodynamic load, brain natriuretic peptide and left atrial size in the early stages of essential hypertension

OBJECTIVE: Left atrial (LA) enlargement is an index of adverse cardiovascular events. We sought to investigate any possible correlation between haemodynamic load, neurohumoral factors and LA size in the early stages of essential hypertension. METHODS: We studied 94 consecutive middle-aged subjects, with newly diagnosed stage I-II essential hypertension without left ventricular (LV) hypertrophy and 34 age and sex-matched normotensive individuals. Ambulatory blood pressure (BP) monitoring, plasma levels of brain natriuretic peptide (BNP), metabolic profile and left atrial volume index (LAVI), an echocardiographic measurement of LA volume indexed for the body surface area, constituted the work-up of all subjects. RESULTS: Hypertensive compared with normotensive subjects had significantly increased office and ambulatory systolic and diastolic BP (P < 0.0001 for all cases) as well as body mass index and waist-to-hip ratio (P < 0.05 for both cases). BNP levels were greater in hypertensive compared with normotensive subjects but were not statistically significant (20.4 versus 17.1 pg/ml, P = NS). Hypertensive compared with normotensive subjects also had significantly increased LV mass index (105 versus 84 g/m, P < 0.0001), LA diameter (39 versus 36 mm, P < 0.0001), and LAVI (22 versus 19 ml/m, P < 0.05). In the hypertensive population, LAVI exhibited significant positive relationships with office systolic BP, ambulatory pulse pressure, LV mass index and BNP. In multiple linear regression analysis only LV mass index and BNP were significantly associated with LAVI (beta = 0.298, P = 0.030 and beta = 0.322, P = 0.009, respectively). CONCLUSIONS: Increased LAVI, closely associated with LV mass index and BNP, was still found in the early stages of essential hypertension. However, the clinical significance of these findings remains to be elucidated in future studies.     

Intraluminal Intestinal Administration of Oxygenated Perfluorocarbon Improves Acid–Base and Cardiopulmonary Parameters After Acute Mesenteric Ischemia. An Experimental Study in Rabbits

Purpose The aim of this study was to evaluate the effects of the intraluminal intestinal administration of oxygenated perfluorocarbon, during experimental acute intestinal ischemia, on the acid–base blood status and the cardiopulmonary parameters. Methods Thirty-six rabbits were separated into three groups: (a) Control group (ischemia alone), (b) PFC-O₂ group (ischemia plus infusion of oxygenated F-Decalin in intraluminal intestinal administration), and (c) PFC group (ischemia plus infusion of nonoxygenated F-Decalin in intraluminal intestinal administration). An equal number of the animals was then subjected to 8 h of intestinal ischemia by ligation of the superior mesenteric artery (subgroups 1), the mesenteric vein (subgroups 2) or both vessels (subgroups 3). At 0, 2, 4, 6, and 8 h arterial blood samples were taken for acid–base status tests and the vital signs (heart and respiratory rate, pressure of inferior vena cava, and systolic arterial pressure) were noted. The statistical analysis was performed by the nonparametric Kruskal–Wallis test. Results There were no significant differences in any of the studied parameters (pH, base excess, respiratory gases, pressure of inferior vena cava, systolic arterial pressure, heart and respiratory rate) between animals of the same group and subgroup. In addition, the differences among Control and PFC groups and their equal subgroups were not significant. On the other hand, the measurements of the PFC-O₂ animals showed significant differences at 4, 6, and 8 h of ischemia (P < 0.05) in comparison with those from the Control and PFC groups. Conclusion We conclude that the intraluminal intestinal administration of oxygenated perfluorocarbons may thus be a useful adjunctive therapy in the treatment of patients with acute mesenteric ischemia.     

Uncontrollable Intra-Abdominal Bleeding Necessitating Low Anterior Resection of the Rectum After Stapled Hemorrhoidopexy: Report of a Case

Stapled hemorrhoidopexy (SH) has become a widely accepted surgical procedure for hemorrhoids; however, one of the most serious complications of this technique is severe bleeding. We report a case of extensive hemoperitoneum after SH for third-degree hemorrhoids. On postoperative day (POD) 1, the patient complained of severe abdominal pain and clinical signs of peritonitis soon became evident. Computed tomography (CT) showed blood in the abdomen. We performed an emergency exploratory laparotomy, which revealed extensive hemoperitoneum, and a devitalized, edematous rectum with a tense hematoma, approximately 1 cm above the staple line and extending up to the level of the peritoneal reflection. We also found a small seromuscular laceration in the anterior aspect of the rectum just above the peritoneal reflection. This small laceration was bleeding actively. Thus, we performed a low anterior resection and the patient was discharged from hospital 10 days later. We report this case to raise awareness of the possibility of life-threatening intra-abdominal complications without evidence of typical rectal bleeding.     

Orbital metastasis from verrucous carcinoma of the oral cavity: case report and review of the literature

A rare case of metastatic verrucous carcinoma (VC) of the oral cavity is presented. The patient was referred to the Ophthalmology Department due to diplopia. The patient reported history of diagnosis of verrucous squamous carcinoma in the oral cavity occuring 6 years earlier that although excised presented several recurrences. The lesion metastasized to local lymph nodes and after being characterized as inoperable the patient underwent thirty-seven sessions of radiation therapy. Two months after completion of radiation therapy, the patient underwent an orbital CT scan that revealed a mass with morphological features consistent with secondary involvement of the orbit from the known VC. Although treated with chemotherapy, the patient died 5 months later. No other case of this entity, which usually presents as a slow-growing lesion enlarging with direct extension rather than frank invasion, metastasizing to the orbit has been reported in relevant literature.     

Cognitive and neural foundations of religious belief

We propose an integrative cognitive neuroscience framework for understanding the cognitive and neural foundations of religious belief. Our analysis reveals 3 psychological dimensions of religious belief (God''s perceived level of involvement, God''s perceived emotion, and doctrinal/experiential religious knowledge), which functional MRI localizes within networks processing Theory of Mind regarding intent and emotion, abstract semantics, and imagery. Our results are unique in demonstrating that specific components of religious belief are mediated by well-known brain networks, and support contemporary psychological theories that ground religious belief within evolutionary adaptive cognitive functions.Religious belief and behavior are a hallmark of human life, with no accepted animal equivalent, and found in all cultures (1). The biological basis of religion, though, is fiercely debated in fields as diverse as evolutionary psychology, anthropology, genetics, and cosmology. Contemporary psychological theories consider religious belief and behavior as complex brain-based phenomena that may have co-emerged in our species with novel cognitive processes for social cognition, such as Theory of Mind (ToM), and successfully engaged fundamental cognitive mechanisms, such as memory (2–4).Remarkably little is currently known about the neural foundations of religiosity. Cognitive neuroscience studies have so far focused on the neural correlates of unusual and extraordinary religious experiences (5, 6), whereas clinical studies have focused on pathological religious manifestations. Hyperreligiosity in patients with temporal-lobe epilepsy motivated early theories linking religiosity with limbic and temporal areas (7, 8), executive aspects and prosocial roles of religion (9) shifted the focus to the frontal lobes (10), while decreased parietal lobe activity was linked to mystical religious experiences (5). Overall, these findings show a low degree of correspondence and no relationship to any proposed psychological architecture underlying religious belief.The aim and motivation of our research was to define the psychological structure of religious belief, based on fundamental cognitive processes, and to reveal the corresponding pattern of brain activation to determine the relevance of evolutionary theories of cognitive development to the development of religious beliefs. To this end, it was necessary to model the complexity of religious belief.Factor analytic studies have demonstrated that an underlying psychological structure can be described for religious belief and have established the perceptions of God''s level of involvement and God''s level of anger as key organizing components (11). Processing these components presupposes intent-related and emotional ToM being applied to supernatural agents, a fact that links fundamental aspects of social cognition to religious belief. Besides these components, any belief system relies on a body of semantic and event knowledge. One source of semantic knowledge for religious belief is doctrine, a body of concepts regarding supernatural agents and entities, which believers accept as real despite not being verified by personal experience. Aspects of doctrine may be rooted in intuitive world-theory creation inherent in all humans, such as belief in the existence of nonmaterial agents (1), but for the most part doctrine has abstract linguistic content, is specific to the various institutionalized religions, and is culturally transmitted (3). Another source of religious knowledge is event knowledge stemming from personal experiences explicitly religious (such as prayer or participation in ritual), but also from multiple social and moral events influenced by religion (3). In this view, religious knowledge forms a continuum from doctrinal to experiential, and most beliefs draw from both sources. Moreover, adoption and implementation of religious beliefs is influenced by emotions and goals. For example, a set of doctrinal beliefs about the soul may lead through logical reasoning to a moral rule regarding euthanasia, but an applied moral stance would also draw from experience and take the particular circumstances and their emotional significance into account.Based on the above psychological structure, we hypothesized that religious belief relates to specific patterns of brain activation. First, we hypothesized that the 2 previously identified components (God''s involvement and God''s anger) (11) engage ToM-related prefrontal and posterior regions. Second, we hypothesized that the proposed continuum of religious knowledge differentially engages associative processes: doctrinal knowledge engages networks processing abstract semantics (3), whereas experiential knowledge engages networks involved in memory retrieval and imagery (3). Third, we predicted that adoption of religious belief engages networks providing cognitive-emotional interface.We conducted a multidimensional scaling (MDS) study to determine the psychological components underlying religious belief (Experiment 1) and evaluated their neural foundations by employing a parallel functional neuroimaging study (Experiment 2).