Circulating cell-free DNA is associated with cardiometabolic risk factors: The Health 2000 Survey

Cell-free circulating DNA (cf-DNA) has recently arisen as a promising biomarker in acute cardiovascular pathologies and as a mortality predictor in myocardial infarction. We wanted to investigate whether the baseline cf-DNA concentration could serve as an indicator of increased cardiovascular risk and early atherosclerosis. The study population consisted of 1337 participants (aged 46–77 years) in the Health 2000 Survey. cf-DNA was quantified directly in plasma using the fluorescence-based Quant-iT™ high-sensitivity DNA assay kit. Increased cf-DNA levels paralleled a cluster of cardiometabolic risk factors, such as high blood pressure, unfavorable lipid metabolism profile and systemic inflammation in both sexes. In addition, higher cf-DNA levels indicated decreased arterial elasticity and glucose intolerance in women not using hormonal replacement therapy (HRT). The cf-DNA level was also observed to be an independent determinant for Young's elastic modulus but not for carotid artery compliance or beta stiffness index in the women not using HRT. Hence, we conclude that cf-DNA could serve as an auxiliary biomarker in cardiometabolic risk assessment and as an indicator of arterial stiffness in women not using HRT.     

Indoleamine 2,3-dioxygenase (IDO) activity is lower in atopic than in non-atopic individuals and is enhanced by environmental factors protecting from atopy

Tryptophan catabolism activated by the indoleamine 2,3-dioxygenase (EC 1.13.11.42) (IDO) enzyme in antigen presenting cells has a central role in induction of mechanisms suppressing T cell activation or clonal expansion. There is evidence suggesting that IDO activity is mainly upregulated by typical Th1-differentiating signals such as interferon-gamma and bacterial lipopolysaccharide (LPS). Therefore, we hypothesized that IDO activity would be lower in a Th2-associated disease such as atopy and that it would be higher in the presence of environmental factors known to favor Th1 differentiation. Here we show that this was the case. Concentrations of tryptophan (trp) and kynurenine (kyn), the main metabolite, were determined by reverse phase liquid chromatography from serum samples of a cohort of 392 non-asthmatic individual of whom 149 were atopics (one or more positive skin test when tested with a panel of 22 allergens). Kyn/trp ratio, as an indicator of IDO activity, was significantly lower in atopic than in non-atopic individuals. The cohort was stratified according to two known atopy-protecting factors, presence of antibodies against Helicobacter pylori or anamnestic information about childhood on a farm environment. As expected, IDO activity was significantly higher in their presence than absence.     

Factors predicting the result of surgery for lumbar intervertebral disc herniation

The prospective study was undertaken to find out preoperative or perioperative factors predicting the results of the first surgery for lumbar disc herniation. The results were evaluated 1 and 6 months postoperatively using, in addition to the patient evaluation, indices for pain, activities of daily living (ADL), and working capacity. The best result was achieved if the patient was operated on before 2 months' duration of disabling sciatica. The operative finding graded as protrusion predicted poor result. The social and psychological factors influenced the outcome more than the findings in the preoperative physical examination or the grade of operative finding. It is recommended to add indices for pain and ADL and a psychological test to the preoperative examinations of patients with lumbar disc herniation.     

Bilateral Achilles tendon rupture: a report on two cases

Two cases of traumatic bilateral Achilles tendon rupture are reported. One of the patients was a healthy middle-aged man, who had been an active nationallevel gymnast 20 years earlier. He had not suffered any complaints of Achilles tendons before. The ruptures occurred when, after a sauna, he showed his guests a vault forwards, which he had been able to perform easily. This time the landing took place on the toes, causing a high peak stretch to the calf muscles and Achilles tendons. The total rupture of both Achilles tendons was treated surgically, with an excellent result 2 days after the trauma. End-to-end suturation and a fascial flap plasty were made on both sides. No macroscopic degeneration could be detected on the rupture sites. He was allowed to walk freely 6 weeks after the surgery. The second case was a 54-year-old woman, who had suffered from Achilles tendinitis and peritendinitis for 2 years. Both tendons had been surgically treated, and severe adhesions and local degenerative changes had been found. The tendon rupture occurred when she injured her left ankle while getting out of the car. Two days later she fell at home, because of the weakness of the left side, and consequently the right Achilles tendon was injured. She was treated conservatively for 10 days, before the surgery was performed. Both tendons were ruptured and an extensive degeneration of the area was observed. The right side suffered from a rerupture, which was again treated surgically. After surgery the recovery was slow, but the final result 3 years later was moderate. Neither of the patients had any systemic diseases.     

Gender differences in psychological and cortisol responses to distress: A five-year follow-up of patients with back pain

To further evaluate gender-related coping strategies, clinical and psychological characteristics of patients with low back pain were related to their serum cortisol levels on admission to hospital and at five-year follow-up after operation and/or rehabilitation. Women expressed more somatization and depression than did men on admission, but gender difference disappeared during follow-up while depressive feeling tended to decrease. Men had more cortisol in blood in the afternoon. Sex explained a significant proportion of the variance in cortisol values at admission, whereas depression, sex and operation contributed to variance at follow-up. It was concluded that gender differences in psychological coping with distress modify cortisol responses to the experience of low back pain.     

Patellofemoral relationships in recurrent patellar dislocation

Magnetic resonance imaging was used to analyse the patellofemoral relationships during the first 30 degrees of knee flexion in women with recurrent patellar dislocation. The patellofemoral joints were imaged both sagittally and axially with the knee flexed 0 degrees, 10 degrees, 20 degrees, and 30 degrees. At the beginning of knee flexion the sulcus angle was greater than in unaffected women, the lateral patellofemoral angle was smaller, the patella displaced further laterally, tilted more laterally and the congruence angle was directed more laterally. At 30 degrees of knee flexion these differences were less marked than at 0 degree to 10 degrees. Logistic regression analysis showed that the sulcus angle at 10 degrees of knee flexion was the most diagnostic feature, indicating that there is an anatomical predisposition to recurrent dislocation and that pathological patellar tracking starts from the beginning of flexion. Traditional sunrise radiographic films taken at 25 degrees to 30 degrees knee flexion clearly miss diagnostically important information.     

Autoimmunity and longevity: presence of antinuclear antibodies is not associated with the rate of inflammation or mortality in nonagenarians

There are reports demonstrating elevated levels of autoantibodies in elderly people. We now analyzed whether the strong inflammatory response associated with aging is interrelated with the production of autoantibodies, antinuclear antibodies (ANA). In a cohort of 284 nonagenarians the rate of ANA positivity was 12.3%, which is significantly (p<0.001) higher than that in the middle-aged controls (2.8%). The mortality data of this cohort was collected after a 4-year follow-up. The ANA positivity at the age of 90 did not have any effect on the rate of survival, or on the levels of serum markers of inflammation.