Lipoprotein-associated phospholipase A2 predicts 5-year cardiac mortality independently of established risk factors and adds prognostic information in patients with low and medium high-sensitivity C-reactive protein (the Ludwigshafen risk and cardiovascular health study)

BACKGROUND: Lipoprotein-associated phospholipase A(2) (LpPLA(2)), also denoted as platelet-activating factor acetylhydrolase, is a lipoprotein-bound enzyme involved in inflammation and atherosclerosis. In this cohort study we investigated LpPLA(2) activity to predict cardiac mortality in patients scheduled for coronary angiography. METHODS: LpPLA(2) activity was determined in 2513 patients with and in 719 patients without angiographically confirmed coronary artery disease (CAD). RESULTS: During the median observation period of 5.5 years, 501 patients died. In patients with tertiles of LpPLA(2) activity of 420-509 U/L or >or=510 U/L, unadjusted hazard ratios (HRs) for cardiac death were 1.7 (95% CI 1.3-2.4; P = 0.001), and 1.9 (95% CI 1.4-2.5; P <0.001), respectively, compared with patients with LpPLA(2) activity 相似文献   

Activity of herbicolin A against Mycoplasma, Acholeplasma, Ureaplasma, and Spiroplasma species

Herbicolin A, a novel acyl peptide antibiotic, inhibits the growth of the sterol-requiring Mycoplasma, Ureaplasma, and Spiroplasma species, with MICs varying from 1.5 to 100 micrograms/ml. With the exception of Acholeplasma modicum, all of the non-sterol-requiring species of the family Acholeplasmataceae were totally resistant to herbicolin A when tested on serum-containing medium but were inhibited to some extent on medium devoid of serum and any other source of sterol or fatty acids.     

Traumatische und degenerative Läsionen der Sehnen an der Hand

Tendon lesions are the second most common injury in the hand and therefore an important factor in orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons; nevertheless, also less frequent injuries such as damage to the functional system of tendon sheath and pulley or dull avulsions need to be considered. Besides the clinical examination, ultrasound and MRI have proven to be important diagnostic tools. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger "intrinsic" tendon healing to guarantee a good outcome.     

Novel association to the proprotein convertase PCSK7 gene locus revealed by analysing soluble transferrin receptor (sTfR) levels

The level of body iron storage and the erythropoietic need for iron are indicated by the serum levels of ferritin and soluble transferrin receptor (sTfR), respectively. A meta-analysis of five genome-wide association studies on sTfR and ferritin revealed novel association to the PCSK7 and TMPRSS6 loci for sTfR and the HFE locus for both parameters. The PCSK7 association was the most significant (rs236918, P = 1.1 × 10E-27) suggesting that proprotein convertase 7, the gene product of PCSK7, may be involved in sTfR generation and/or iron homeostasis. Conditioning the sTfR analyses on transferrin saturation abolished the HFE signal and substantially diminished the TMPRSS6 signal while the PCSK7 association was unaffected, suggesting that the former may be mediated by transferrin saturation whereas the PCSK7-associated effect on sTfR generation appears to be more direct.     

Implications of resistin plasma levels in subjects undergoing coronary angiography

BACKGROUND: The adipokine resistin, which is thought to serve as a link between obesity and insulin resistance, was recently shown to exert proatherosclerotic features. OBJECTIVE: Our study aimed to explore the involvement of resistin in cardiovascular disease by investigating the associations of resistin with angiographic coronary artery disease (CAD), cardiovascular risk factors and mortality. DESIGN: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study is a prospective study of white subjects who had undergone coronary angiography. PATIENTS AND MEASUREMENTS: Resistin levels were determined in 1162 subjects with (n = 911) and without (n = 251) angiographic CAD. During a mean follow-up period of 5.47 years, 198 deaths occurred among our probands. RESULTS: Resistin was positively correlated with C-reactive protein (CRP; r = 0.245, P < 0.001), vascular adhesion molecule-1 (VCAM-1; r = 0.327, P < 0.001) and intercellular adhesion molecule-1 (ICAM-1; r = 0.197, P < 0.001) and was negatively correlated with glomerular filtration rate (GFR; r = -0.438, P < 0.001) and high density lipoprotein (HDL; r = -0.196, P < 0.001). Multiple regression analysis revealed that GFR was the strongest predictive variable for resistin. Angiographic CAD, type 2 diabetes, smoking, hypertension and body mass index (BMI) were not associated with resistin. Compared to the first quartile, we observed an increased risk for cardiovascular and noncardiovascular mortality at the fourth quartile of resistin, but only the association between resistin and noncardiovascular mortality remained significant after multivariable adjustments [hazard ratio (HR) 4.92, 95% confidence interval (CI) 1.66-14.6, P = 0.004]. CONCLUSIONS: Resistin plasma concentrations are related to inflammatory processes and renal function but our study does not support the hypothesis of resistin as an independent cardiovascular risk factor. The unexpected association of resistin with noncardiovascular mortality still warrants further study.     

Exclusion of patients with arteriosclerosis reduces long-term recurrence rate of presumed arterial embolism after PFO closure

BACKGROUND: Percutaneous transcatheter closure of patent interatrial communications after presumed paradoxical embolism is used as an alternative to surgery or long-term anticoagulation for the treatment of patients who are at risk for recurrent thromboembolism. To avoid atherosclerotic events to be judged as recurrent paradoxical embolism, we prospectively excluded all patients with detectable arteriosclerosis from our series and investigated long-term results. METHODS AND RESULTS: We report the outcome of 180 patients who underwent percutaneous transcatheter closure of patent foramen ovale (PFO), PFO like atrial septal defect (ASD), or an ASD because of paradoxical embolism. One hundred four patients had cerebral embolism, 57 had transient ischemic attacks, 16 coronary embolism, and 3 had peripheral embolism. Twenty-three patients experienced multilocal arterial embolism. One hundred twenty-five patients had a PFO, 63 of them with an atrial septal aneurysm (ASA), 24 a PFO-like ASD (7 of them with an ASA), and 31 had an ASD. After 18 months, only 5 patients (2.8%) showed a trivial residual shunt. At a mean follow-up of 40 months (range 4 to 88), resulting in 602 observed patient-years, only 1 patient experienced a presumed paradoxical (coronary) embolism (calculated annual risk to suffer a recurrent thromboembolic event: 0.16%). CONCLUSIONS: Percutaneous transcatheter closure of PFO/ASD is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. It is associated with a high success rate, low incidence of hospital complications, and very low frequency of recurrent systemic embolic events.     

Sleep and periodic limb movements in corticobasal degeneration

Corticobasal degeneration (CBD) exhibits distinct features of akinesia, the 'alien limb' sign and cortical myoclonus. We report a 63-year old woman with a history of CBD for 18 months who was studied twice using all-night polysomnography with an interval of 13 months. Both recordings revealed frequent periodic arm and leg movements predominantly during non-REM sleep. To our knowledge this has not been described in a patient with CBD so far. Similar to a previous report we found REM sleep without atonia (RWA) in all REM episodes. However, the patient showed RWA and some non violent movements that fulfilled the diagnosis of subclinical REM sleep behavior disorder only in the second investigation. These observations may be due to the underlying degenerative process that involves not only cortical but also thalamic and brainstem structures.     

Opioid and dopamine antagonist drug challenges in untreated restless legs syndrome patients

Background: The restless legs syndrome (RLS) is a common sensomotor disorder associated with severe sleep disturbances. Symptoms clearly improve following treatment with dopaminergic or opioidergic agonists.Objective: To further elucidate the involvement of opioidergic and dopaminergic mechanisms in the pathophysiology of RLS, the effects of specific antagonists on motor (periodic leg movements) and subjective (sensory) RLS-symptoms during daytime were assessed.Methods: A modified suggested immobilization test was performed in eight drug-naive RLS-patients. An infusion of either naloxone, metoclopramide or placebo was administered. In addition, the hormonal levels of adrenocorticotropic hormone, cortisol, prolactin and growth hormone were determined, to elucidate a possible involvement of the hypothalamic-pituitary-adrenocortical (HPA) system in RLS.Results: RLS sensory or motor symptoms could not be provoked. Hormonal responses showed no abnormal profiles.Conclusions: Rather than a general alteration of the opioidergic/dopaminergic tone and an involvement of the HPA system, it is more likely that specific neuronal dopaminergic or opioidergic pathways are altered in the pathophysiology of RLS.