Biomarkers of inflammation predict both vascular and non-vascular mortality in older men.

AIMS: To compare the predictive value of inflammatory biomarkers and lipids for vascular and non-vascular mortality in older men. METHODS AND RESULTS: The relevance of inflammatory biomarkers and lipids for vascular and non-vascular mortality was assessed in a prospective study of 5360 men (mean age 77 years) followed for 7 years. Vascular mortality was positively associated with log C-reactive protein (lnCRP), fibrinogen and total/HDL-C (high-density lipoprotein cholesterol), and inversely associated with albumin [age adjusted hazard ratio (HR) per 2-SD higher usual level (approximately the difference between the top and the bottom thirds of the distribution): 2.09 for lnCRP; 1.70 for fibrinogen; 0.50 for albumin and 1.45 for total/HDL-C]. The associations with the inflammatory markers were attenuated after adjustment for established risk factors, including lipids [adjusted HRs: 1.86 (lnCRP); 1.44 (fibrinogen); 0.51 (albumin)], and further attenuated (and, for fibrinogen, no longer predictive) after adjustment for each other [fully adjusted HRs: 1.60 (lnCRP); 1.01 (fibrinogen); 0.61 (albumin)]. Higher CRP and lower albumin levels were also associated with significantly raised non-vascular mortality independently of other characteristics [fully adjusted HRs: 1.62 (lnCRP); 0.65 (albumin)]. CONCLUSION: In this cohort of older men, higher CRP and lower albumin levels strongly predicted both vascular and non-vascular mortality, independently of other characteristics.     

Hypocalcemia. Differential diagnosis and mechanisms.

There is much individual variability in the clinical manifestations of hypocalcemia. The rapidly of the development of hypocalcemia will determine whether or not symptoms will be present. Signs and symptoms of hypocalcemia consisted of tetany (Chvostek's and Trousseau's signs), seizures, diminshed to absent deep tendon reflexes, papilledema, mental changes (weakness, fatigue, irritability, memory loss, confusion, delusion, hallucination), and skin changes. Etiologic factors for hypocalcemia in man include (1) decreased calcium absorption or increased loss from the gastrointestinal tract; (2) parathyroid hormone deficiency; (3) skeletal resistance to parathyroid hormone; (4) ineffective parathyroid hormone; (5) decreased production or increased degradation of 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol; (6) increased complex formation with calcium; (7) increased skeletal uptake of calcium; (8) hypomagnesemic state; and (9) direct inhibition of bone resorption. Measurement of total and ionic calcium, magnesium, parathyroid hormone, vitamin D metabolites (25-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol), and nephrogenous cyclic adenosine monophosphate are especially helpful in the laboratory evaluation of the hypocalcemic patient.     

Acute necrotizing esophagitis

Acute necrotizing esophagitis is a rare disease. Its pathogenesis is influenced by situations of low systemic perfusion, such as hypertension, heart failure or sepsis, in which other factors, such as the application of a nasal tube, infections or drugs also play a role. We present a case of acute necrotizing esophagitis in a patient with copious vomiting, renal failure, gastric hemorrhage due to Mallory-Weiss syndrome and esophageal infection due to Actinomyces. The patient was undergoing coadjuvant chemotherapy for a surgically-treated colonic neoplasia. Maintenance therapy produced favorable evolution with restoration of esophageal epithelium and no stenotic complications.     

Evidence that endothelin-1 (ET-1) inhibits insulin-stimulated glucose uptake in rat adipocytes mainly through ETa receptors

The specificity of endothelin (ET) receptors involved in the inhibition of insulin-stimulated glucose uptake (ISGU) in rat adipocytes was investigated. Adipocytes were isolated from the epididymal fat pads of Sprague-Dawley rats. To determine receptor subtypes, we used three ET isopeptides, ET-1 and ET-2, both of which are nonselective agonists, and ET-3, a selective agonist for ETc receptors, to displace [¹²⁵I]ET-1 binding from the fat cells. The efficiency of displacement was ET-1 > ET-2 ? ET-3, indicating that the primary receptors involved belonged to the ETa subtype. At an equal concentration of 1 μmol/L, BQ-610, a selective ETa antagonist, displaced [¹²⁵I]ET-1 from binding to fat cells, whereas IRL-1038, a selective ETb antagonist, did not. Using [³H]2-deoxy-d-1-glucose ([³H]2-DG) as a tracer in studies of glucose uptake, we found that equimolar BQ-610 completely reversed the inhibitory effect of ET-1 on ISGU, whereas IRL-1038 was ineffective. Northern blot analysis of adipocyte receptors showed abundant mRNA for ETa, but no ETb subtype. These results clearly demonstrate that ETa is the predominant receptor in rat adipocytes.     

血糖,血浆胰岛素水平与血压升高的关系发生于糖尿病之前？

对年龄２５岁～７４岁２０１例糖耐量正常（ＮＯＧＴＴ）、３０７例ＩＧＴ、３６６例新发现ＮＩＤＤＭ，进行Ｐｅｒｓｏｎ单相关分析。年龄、性别、ＢＭＩ、空腹及服糖后血糖、胰岛素（ＩＮＳ）水平分别与血压正相关，调整年龄、性别、ＢＭＩ、血浆胆固醇、抽烟等因素后，ＮＯＧＴＴ及ＩＧＴ血糖与血压相关，ＮＩＤＤＭ者血糖与血压不相关，提示血糖水平对血压的影响发生于糖尿病之前。ＮＯＧＴＴ、ＩＧＴ、和ＮＩＤＤＭ总组，ＮＯＧＴＴ及ＩＧＴ组血浆ＩＮＳ水平与血压不相关，只有年龄小于５０岁，非肥胖的ＮＯＧＴＴ者血浆ＩＮＳ水平与血压相关，提示血浆胰岛素水平对血压的影响发生于年轻非肥胖的糖耐量正常者。