Screening for undiagnosed diabetes in patients with acute myocardial infarction

Background  Screening for undiagnosed diabetes in patients with acute myocardial infarction is recommended (ESC and EASD Task Force 2007). Glucose tolerance testing in the peri-infarct period may not be valid because of confounding, e.g. by the acute stress reaction. The aim was to evaluate undiagnosed diabetes (DM) and impaired glucose regulation (IGR) in AMI during hospital stay and 3 months after discharge. Materials and methods  In 96 consecutively admitted AMI patients (Heart Center Wuppertal, Germany) OGTT were performed, of whom in 62 OGTT were also carried out 3 months later. Results  Before discharge 32% of the patients had newly diagnosed diabetes and 47% patients had prediabetes (IGR). Glucose tolerance was normal in 20 (21%) patients only. After 3 months, 74% with newly diagnosed DM at baseline still had disturbed glucose metabolism (58% DM, 16% IGT). No patient with normal OGTT became diabetic after 3 months. In multivariate regression, the odds of having diabetes (3 months) was about sixfold higher when having diabetes before discharge (OGTT). Admission glucose, infarction size CK_MAX, and inflammation (CRP) were not significantly related to OGTT results. Conclusions  This prospective study confirms a high prevalence of undiagnosed DM in patients with AMI. In about 60% of AMI patients, newly diagnosed DM persisted after 3 months. For the first time we could show that there is no correlation between infarction size and undiagnosed diabetes. Thus, an OGTT performed before discharge may provide a reliable measure of disturbed glucose regulation but needs to be repeated. M. Lankisch and R. Füth equally contributed to this work.     

Dickkopf-4 is frequently down-regulated and inhibits growth of colorectal cancer cells

Like Dickkopf-1 (DKK1), DKK4 is a target of β-catenin/Tcf-4 in colorectal cancer. However, as a negative regulator of Wnt signalling its function in colorectal cancer cells is not well understood. We report that DKK4 is frequently down-regulated in colorectal cancer cell lines with deregulated β-catenin/Tcf-4 and in primary colorectal cancers. Exposure of cancer cells to DKK4 strongly inhibits basal β-catenin/Tcf-4 signalling activity, cancer cell growth and cell cycle progression. Therefore, loss of this negative feed-back loop provides Wnt factor expressing cancer cells with a growth advantage. Our data demonstrate that DKK4 is an important negative regulator of colon cancer cell growth.     

Restraint use among nursing home residents: cross‐sectional study and prospective cohort study

Aims and objectives. To investigate (1) the prevalence of physical restraints and psychoactive medication, (2) newly administered physical restraints, frequency of application of the devices and frequency of psychoactive medication on demand during 12‐month follow‐up and (3) characteristics associated with restraint use in nursing homes. Background. High quality data on restraint use in German nursing homes are lacking so far. Such information is the basis for interventions to achieve a restraint‐free care. Design. Cross‐sectional study and prospective cohort study. Setting and subjects. Thirty nursing homes with 2367 residents in Hamburg, Germany. Methods. External investigators obtained prevalence of physical restraints by direct observation on three occasions on one day, psychoactive drugs were extracted from residents’ records and prospective data were documented by nurses. Results. Residents’ mean age was 86 years, 81% were female. Prevalence of residents with at least one physical restraint was 26·2% [95% confidence interval (CI) 21·3–31·1]. Centre prevalence ranged from 4·4 to 58·9%. Bedrails were most often used (in 24·5% of residents), fixed tables, belts and other restraints were rare. Prevalence of residents with at least one psychoactive drug was 52·4% (95% CI 48·7–56·1). The proportion of residents with at least one physical restraint after the first observation week of 26·3% (21·3–31·3) cumulated to 39·5% (33·3–45·7) at the end of follow‐up (10·4 SD 3·3 months). The relative frequency of observation days with at least one device ranged from 4·9–64·8% between centres. No characteristic was found to explain centre differences. Conclusions. The frequency of physical restraints and psychoactive drugs in German nursing homes is substantial. Pronounced centre variation suggests that standard care is possible without restraints. Relevance to clinical practice. Effective restraint minimisation approaches are urgently warranted. An evidence‐based guideline may overcome centre differences towards a restraint‐free nursing home care.     

Quantification of dyskinesia in Parkinson's disease: validation of a novel instrumental method.

We used a rotation-sensitive movement monitor (RoMM) to quantify and characterize dyskinesia in Parkinson's disease (PD). Both upper limbs of 22 patients with dyskinetic PD were recorded and videotaped simultaneously. Three neurologists reviewed the video segments and rated severity of dyskinesia on a four-point scale; they also assessed any asymmetry of dyskinesia between the right and left side as well as the dyskinesia type (choreic, dystonic, or mixed). Mean and median clinical ratings for severity, asymmetry, and type of dyskinesia were compared with (1) the total power of the frequency power spectrum (FPS, degrees/second), (2) the percent difference of FPS values between the right and left side, and (3) the frequency (Hz) of the predominant peak, respectively. Intra- and interrater reliability was determined and a test-retest analysis was performed. FPS values showed a statistically significant correlation with the clinical ratings for dyskinesia severity. FPS difference between both sides was more sensitive than raters in detecting dyskinesia asymmetry. A predominant frequency peak of dyskinesia was obtained in all cases and ranged from 0.25-3.25 Hz. There was a significant trend for high-frequency dyskinesia to correlate with choreic type and for low-frequency dyskinesia to correlate with dystonic type. Test-retest analysis indicated a high reliability. We conclude that the RoMM is a valid, reliable, and sensitive method to quantify and characterize dyskinesia. Examples are provided suggesting that this instrument may prove useful for long-term assessment of dyskinetic patients and as a standardized tool for assessing dyskinesia in pharmaceutical or surgical trials for PD.