Ultrasonic Tissue Characterization of Carotid Plaque Improves the Prediction of Cardiovascular Events in Diabetic Patients: A pilot study

OBJECTIVE

The aim of this study is to evaluate whether noninvasive ultrasonic tissue characterization of carotid plaque using integrated backscatter (IBS) analysis can be a predictor of future cardiovascular events (CVE) in asymptomatic type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

We prospectively evaluated the association between Calibrated-IBS value, an ultrasonic marker for tissue characteristics of carotid plaque, and CVE in 85 asymptomatic type 2 diabetic patients with carotid plaque.

RESULTS

The median follow-up period was 7.9 years, and there were 20 new CVE. The risk of CVE was significantly higher in the subjects with low Calibrated-IBS values (<−17.1 dB; n = 42) as compared with those with high values (≥−17.1 dB; n = 43) (P = 0.004, log-rank test). Cox proportional hazards regression analysis revealed that both Calibrated-IBS value (hazard ratio [HR] 0.802 [95% CI 0.710–0.906]; P < 0.0001) and plaque thickness (1.938 [1.170–3.213]; P = 0.010) were independently associated with CVE, even after adjustment for the 10-year risk for a general cardiovascular disease estimated by Framingham risk scoring (FRS). Time-dependent receiver operating characteristic curve analysis for CVE at 10 years after the baseline examinations revealed that area under the curve for Calibrated-IBS was 0.76 (0.60–0.90) and substantially higher than those for plaque thickness (0.60 [0.45–0.79]) and FRS (0.60 [0.40–0.78]). These analyses also revealed that the addition of both plaque thickness and Calibrated-IBS value to conventional risk factors significantly improved the event prediction.

CONCLUSIONS

Calibrated-IBS value could improve the risk prediction of CVE in asymptomatic type 2 diabetic patients with carotid plaque.Cardiovascular disease (CVD), such as myocardial infarction and ischemic stroke, is a major cause of death and impairment of quality of life in patients with type 2 diabetes mellitus (T2DM) (1,2), and its risk in these patients is two- to fourfold higher compared with the general population. Therefore, the early detection of high-risk groups for CVD is critical in the management of diabetic patients. However, cardiovascular risk assessment based on conventional risk factors does not fully explain the distribution of risk (3,4), because these risk factors do not directly reflect structural and functional changes in arteries that are closely associated with CVDs.Previous studies have revealed that the presence of carotid plaque and carotid intima-media thickness (CIMT), which can be assessed quickly, noninvasively, and economically with high-resolution ultrasound, are correlated with conventional coronary risk factors and regarded as reliable markers for systemic atherosclerosis and cardiovascular events (CVE) (5–8). However, it is still controversial whether the addition of CIMT or the presence of carotid plaque to conventional coronary risk factors could improve the prediction ability for CVE (9–11).Disruption of an atherosclerotic plaque plays a crucial role in the pathogenesis of cardiovascular event (12). As plaque disruption is dependent on the content of lipid in the atheroma and the thickness of the fibrous cap (12,13), tissue characterization of a plaque may be useful for determining its fragility. Previous studies showed that integrated backscatter (IBS) signal obtained by ultrasound examination of the carotid artery can be used to noninvasively distinguish among the tissue characteristics of arterial plaque and that low Calibrated-IBS value in the carotid plaque corresponded to atheromatous lesion (14–17). Recently, based on cross-sectional surveys, Calibrated-IBS values in the carotid have been revealed to be significantly lower in subjects with a history of CVD (15,18). However, it remains to be evaluated whether ultrasonic tissue characterization of carotid plaque using IBS analysis can be a predictor of future cardiovascular event in T2DM patients.The aim of this study was to examine whether noninvasive ultrasonic tissue characterization of carotid plaque using IBS analysis can provide useful information for identifying subjects with a high risk for CVE.     

Postnatal depression, maternal bonding failure, and negative attitudes towards pregnancy: a longitudinal study of pregnant women in Japan

Postnatal depression and bonding failure after childbirth are major mental health issues. We investigated 99 pregnant women on three occasions (late in pregnancy and 5 days and 1 month postnatally). Anxiety during pregnancy predicted postnatal depression and bonding failure, whereas negative attitudes towards pregnancy predicted bonding failure. The effect of negative attitudes towards pregnancy on postnatal depression was possibly mediated by bonding failure. Postnatal depression and bonding failure are correlated with different risk factors and run rather independently over the course of the puerperium. Postnatal depression may be predicted by bonding failure.     

Protective effect of 17β-estradiol on ischemic acute kidney injury through the renal sympathetic nervous system

Enhanced renal sympathetic nerve activity during an ischemic period and renal venous norepinephrine overflow after reperfusion play important roles in the development of ischemic acute kidney injury. In this study, we examined the effect of 17β-estradiol on the renal sympathetic nervous system and kidney function in ischemia/reperfusion-induced acute kidney injury in anesthetized rats. Ischemic acute kidney injury was induced by clamping the left renal artery and vein for 45 min followed by reperfusion, 2 weeks after a contralateral nephrectomy. Intravenous injection of 17β-estradiol (100 μg/kg) 15 min before reperfusion suppressed enhanced renal sympathetic nerve activity during renal ischemia, also suppressed renal venous norepinephrine overflow after reperfusion, and attenuated ischemia/reperfusion-induced renal dysfunction with histological damage. The above renoprotective effects of 17β-estradiol were reversed by pretreatment with tamoxifen (5 mg/kg), an estrogen receptor antagonist, or N(G)-nitro-L-arginine methyl ester (0.3 mg/kg), a non-selective nitric oxide synthase inhibitor. These results indicate that 17β-estradiol can suppress enhanced renal sympathetic nerve activity during renal ischemia, and its consequent effect on norepinephrine overflow from nerve endings, by nitric oxide production via estrogen receptors. These effects appear to contribute to renoprotection against ischemia/reperfusion-induced renal injury.     

Establishment of an educational program concerning adverse drug reaction reporting-system in long-term practical training at a hospital

The model core curriculum for pharmaceutical education specifies the specific behavioral objectives (SBOs) concerning adverse drug reactions, which aims to train pharmacy students to manage adverse drug reactions. Fukuoka University Hospital has developed a problem-based learning (PBL) program concerning adverse drug reactions as long-term practical training to collect adverse event information, identify adverse effects, and acquire management skills. Students' level of satisfaction with the program was high (approximately 90%), and the mean self-evaluation score for the SBOs concerning adverse reaction was 4.4 (5-grade scale), showing a high level of understanding. In addition, students' will of participation to the adverse drug reaction-reporting system was significantly improved after the PBL program, showing the usefulness of this program (p=0.02). However, the results of the PBL program revealed students' insufficient knowledge of adverse reactions and lack of reviewing skills, suggesting the need to improve the education system whereby students can learn adverse drug reactions in clinical settings.     

Factors related to the continuation of employment during pregnancy among Japanese women

Aim: To determine the relationship between the working situation (full‐time housewife, stopped working during pregnancy, or currently employed) and the lifestyle factors, reasons for stopping work during pregnancy, and effects of working conditions in order to identify the factors that are related to the continuation of employment among pregnant Japanese women. Methods: In a cross‐sectional study, a questionnaire was administered to pregnant women who visited an obstetrics clinic in a Tokyo suburb for an outpatient medical check‐up during July and August 2004. Results: The data of 530 healthy pregnant women were analyzed. The pregnant women who stopped working during their pregnancy had lower mental health scores than the full‐time housewives and employed pregnant women. In each trimester, the employed pregnant women reported a shorter daytime sleep duration than the pregnant women who stopped working during their pregnancy and the full‐time housewives. The reasons for stopping work during pregnancy were categorized as somatic symptoms due to pregnancy, working conditions, and a sense of values or social reasons. The employed women in the third trimester more often reported the availability of, and access to, a rest area in their company, compared to those in the first and second trimesters. Conclusion: The lifestyle factors of the pregnant women were different, based on their work situation. In particular, the employed pregnant women had a shorter daytime sleep duration. The pregnant women who stopped working during their pregnancy could have benefited from mental health support. In addition, the reasons for stopping work during pregnancy were different in the three trimesters. A flexible system is needed for working women that adapts to the physical changes that occur during pregnancy.     

Economic consequences of post-kala-azar dermal leishmaniasis in a rural Bangladeshi community

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis. Bangladesh national treatment guidelines during the study period called for 120 intramuscular injections of sodium antimony gluconate (SAG). We assessed care-seeking behavior, diagnosis and treatment costs, and coping strategies among 134 PKDL patients; 56 (42%) patients had been treated with SAG, and 78 (58%) remained untreated. The median direct cost per patient treated was US$367 (interquartile range [IQR] = 90-284), more than two times the estimated per capita annual income for the study population. The most common coping strategy was to take a loan; the median amount borrowed was US$98 (IQR = 71-150), with a median interest of US$32 (IQR = 16-95). Households lost a median of 123 work-days per patient treated. The current regimen for PKDL imposes a significant financial burden, reinforcing the link between poverty and visceral leishmaniasis. More practical shorter-course regimens for PKDL are urgently needed to achieve national and regional visceral leishmaniasis elimination goals.     

YKL-40, a new biomarker of endothelial dysfunction, is independently associated with albuminuria in type 2 diabetic patients

KCNJ11 gene mutations are related to permanent neonatal diabetes mellitus (PNDM). Glycemic stability minimizes the risk of complications. Sulfonylureas (SU) are the proven best therapeutic option. We report a 18-month follow-up of switching from insulin to SU in a mother and her daughter with PNDM due to KCNJ11 mutation.     

Aldose reductase C-106T gene polymorphism is associated with diabetic retinopathy in Japanese patients with type 2 diabetes

It is likely that the C allele of the polymorphism at position −106 in the promoter of aldose reductase gene, which codes a rate-limiting enzyme of the polyol pathway, is a susceptibility allele for diabetic retinopathy in Japanese type 2 diabetic patients.