Plasma triglycerides and LDL cholesterol are related in a parabolic fashion in the general population and patients with Type 2 diabetes mellitus: long‐term follow‐up results from the Hoorn study

Aims Low‐density lipoprotein cholesterol (LDL‐C) levels are often fairly normal in Type 2 diabetes mellitus (DM). We anticipated that a parabolic relation between plasma triglycerides and LDL‐C, as previously demonstrated in familial combined hyperlipidaemia (FCHL), might account for this phenomenon. Methods Our hypothesis was tested in 1343 subjects derived from the general population who were studied on two occasions 6 years apart (the Hoorn study). Three groups were constructed depending on plasma triglycerides: group A (individuals with both measurements below 1.5 mmol/l), group B (one measurement below and one above 1.5 mmol/l) and group C (both measurements above 1.5 mmol/l). Diabetes status was ascertained by an oral glucose tolerance test. Results In a mixed linear model, a significant, positive relation between triglycerides and LDL‐C was observed for males in group A (β_a = 0.5, P < 0.001) and group B (β_b = 0.2, P < 0.001), whereas a significant negative relation was found for males in group C (β_c = ?0.2, P = 0.003). The regression slopes did not differ between diabetic and non‐diabetic subjects. Similar results were obtained for women, with the exception that the relation was not significantly negative in group C (β_c = ?0.1, P = 0.4). Conclusion Plasma triglcyerides and LDL‐C are related in a parabolic fashion, not only in FCHL, but also in the general population and Type 2 DM. These findings aid our interpretation of typical dyslipidaemia and the effects of treatment that are frequently observed in hypertriglyceridaemic states.     

Selective elution of HLA antigens and beta 2-microglobulin from human platelets by chloroquine diphosphate

To determine whether chloroquine can specifically elute HLA antigens and beta 2-microglobulin (beta 2-M) from the platelet surface, quantitative immunofluorescence flow cytometry and monoclonal antibodies were used to show that HLA antigens and beta 2-M were proportionally eluted from the platelet surface without affecting the membrane glycoproteins IIb and IIIa. Second, an autoradiogram of electrophoresed I125-labeled platelets showed that only beta 2-M but not other I125-labeled membrane proteins could be eluted. Although HLA antigens were poorly labeled by I125 and could not be detected on the autoradiogram, the eluted HLA antigens could be detected by anti-HLA monoclonal antibody and immunoblotting techniques. No loss of plasma membrane integrity was observed by transmission electron microscopy after chloroquine treatment of platelets. The results indicate that chloroquine selectively elutes HLA antigens and their noncovalently associated beta 2-M without affecting other integral platelet membrane proteins.     

低血糖指数膳食改善超重老年糖尿病患者氧化应激水平

目的:观察低血糖指数的膳食对2型糖尿病患者氧化应激状态的影响。方法:2004-10/11在上海市静安区二个社区卫生服务中心招募受试者,经医生明确诊断为2型糖尿病、病程超过6个月,体质量指数≥24kg/m2的老年糖尿病志愿者43名,受试者对试验知情同意。采用随机交叉试验随机分配至低血糖指数饮食组和高血糖指数饮食组,每种膳食分别连续使用4周,间隔洗脱期4周,比较试验前后患者超氧化物歧化酶、脂质过氧化产物丙二醛和谷胱甘肽过氧化物酶含量的变化。结果:受试者依从性好,除1人因试验期间发现肿瘤而退出试验,42名志愿者按设计要求完成试验。膳食干预后低血糖指数饮食组和高血糖指数饮食组的超氧化物歧化酶活力分别升高了15.68%和21.33%,丙二醛水平分别下降23.94%和21.55%,谷胱甘肽过氧化物酶活力分别升高了15.74%和17.09%;干预后低血糖指数饮食组丙二醛下降水平与高血糖指数饮食组比较差异有显著性意义(P<0.05),而超氧化物歧化酶和谷胱甘肽过氧化物酶活性两组间差异无显著性意义(P>0.05)。结论:在控制总能量的基础上给予平衡膳食能够改善其氧化应激水平,采用低血糖指数食物有助于氧化应激水平的改善。     

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

INTRODUCTION

Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space.

PATIENTS AND METHODS

In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids.

RESULTS

With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0).

CONCLUSIONS

This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.     

Disease and symptom burden in systemic sclerosis: a patient perspective

OBJECTIVE: Studies of systemic sclerosis (SSc) have enlisted measures of physical function and generic health-related quality of life in order to determine health status. However, the measurements obtained may not discriminate other essential quality of life (QOL) domains important to patients with SSc. Our study used qualitative methods to evaluate patients' assessment of disease and symptom burden in SSc. METHODS: We conducted 3 focus groups and 5 in-depth interviews of patients with SSc. Guiding questions were based on 5 themes: patient awareness, SSc-related problems, disease activity and progression, symptoms, and expectations. Thematic analysis was conducted using qualitative, grounded theory methodologies. RESULTS: Symptoms such as pain (localized or generalized), fatigue, and malaise were reported to have major influence on daily activities and QOL. Gastrointestinal symptoms were among the worst prevalent and disruptive physical problems. All participants reported significant disruptions in their social lives, a burden considered by many as the worst consequence of their disease. All expressed major effects on their overall well-being because of emotional distress, including depression, low self-esteem, concerns with physical appearance, and uncertainty about future outcomes. CONCLUSION: Patients with SSc report significant symptomatic and emotional burdens, which, in turn, affect their QOL and psychological well-being. Additional research and fuller awareness of the disease and symptom-related burdens experienced by patients with SSc may lead to additional relevant outcome measures and more effective overall treatment programs.     

IL-6 transsignalling modulates the early effector phase of EAE and targets the blood-brain barrier

Interleukin-6 (IL-6) plays a crucial role in the pathogenesis of experimental autoimmune encephalomyelitis (EAE). It exerts its cellular effects by a membrane-bound IL-6 receptor (IL-6R), or, alternatively, by forming a complex with the soluble IL-6R (sIL-6R), a process named IL-6 transsignalling. Here we investigate the role of IL-6 transsignalling in myelin basic protein (MBP)-induced EAE in the Lewis rat. In vivo blockade of IL-6 transsignalling by the injection of a specifically designed gp130-Fc fusion protein significantly delayed the onset of adoptively transferred EAE in comparison to control rats injected with PBS or isotype IgG. Histological evaluation on day 3 after immunization revealed reduced numbers of T cells and macrophages in the lumbar spinal cord of gp130-Fc treated rats. At the same time, blockade of IL-6 transsignalling resulted in a reduced expression of vascular cell adhesion molecule-1 on spinal cord microvessels while experiments in cell culture failed to show a direct effect on the regulation of endothelial adhesion molecules. In experiments including active EAE and T cell culture, inhibition of IL-6 transsignalling mildly increased T cell proliferation, but did not change severity of active MBP-EAE or regulate Th1/Th17 responses. We conclude that IL-6 transsignalling may play a role in autoimmune inflammation of the CNS mainly by regulating early expression of adhesion molecules, possibly via cellular networks at the blood-brain barrier.     

In search of a rational approach to chronic kidney disease detection and management

Rates of incident end-stage renal disease persist above established goals, driving efforts for early identification of chronic kidney disease (CKD) to reduce progression. The detection of CKD using existing electronic data sources has been proposed as an efficient identification method; however, this method is not without potential challenges and limitations.     

Knowledge and awareness of peripheral vascular disease are poor among women at risk for cardiovascular disease

OBJECTIVE: Peripheral vascular disease (PVD), a manifestation of systemic atherosclerosis, is an independent risk factor for cardiovascular (CV) morbidity and mortality. PVD research has traditionally focused on male patients; thus, there is a lack of current studies focusing specifically on women. In a cross-sectional study, we assessed the prevalence of PVD and associated atherosclerotic risk factors in ambulatory women veterans as well as knowledge and awareness of PVD and its consequences. MATERIALS AND METHODS: We screened 162 ambulatory women veterans aged 40 to 85 who were enrolled for outpatient care at an urban, tertiary care, teaching hospital. Of 207 women who responded to advertisements or mailings about the study, 78.3% met eligibility criteria and gave informed consent to participate. The participants (N = 162, mean age 54.8 +/- 9.3 years) were evaluated via chart review and noninvasive screening procedures (ankle-brachial index [ABI]; carotid artery intimal-medial thickness [IMT]). PVD was defined by having an ABI 1.0 mm, documented PVD, or previous leg revascularization. CV risk levels were determined using a modification of the Framingham risk level score: low risk, +0-1 risk factor; moderate risk, +2 risk factors; and high risk, >or=2 risk factors. Women's knowledge and awareness were assessed with a psychometrically sound survey (average subscale reliability: 0.942) about risk factors, symptoms, and health consequences associated with PVD. RESULTS: Of 162 patients, 66.2% were white and 84.2% had at least some college education. An ABI 1.0 mm was detected in 21.1%, while 1.2% had a prior diagnosis of PVD and 1.9% had previous leg revascularization. Risk factor stratification was as follows: low risk in 32.1%, moderate risk in 20.4%, and high risk in 47.5% of patients. Knowledge and awareness scores (% correct) for PVD were low regardless of CV risk factor group: low-risk average score was 45.7%; moderate risk, 42.1%; and high risk, 46.9% (F = 0.431, P = 0.650). Likewise, low scores for knowledge of CV risk factors and consequences were found in all CV risk factor groups: low-risk average score was 53.6%; moderate risk, 53.8%; and high risk, 54.4% (F = .013, P = 0.987). More than 68% of the women reported they had never discussed PVD or risk reduction with their physician, yet more than 44% believed they were at an increased risk for PVD. CONCLUSIONS: Despite the presence of multiple PVD risk factors, women in this study had low levels of knowledge and awareness about vascular diseases. Future work is needed to develop and disseminate information about PVD in women and its role in women's CV health. Improving education about the significance of PVD will allow women and their physicians to assess risk factors and implement preventive measures.     

A population-based case-control study of Selective Serotonin Reuptake Inhibitors (SSRIs) and breast cancer: The impact of duration of use, cumulative dose and latency

Background  

Selective serotonin reuptake inhibitors (SSRIs), a popular class of antidepressants, may increase breast cancer risk by stimulating the secretion of prolactin, a potential tumour promoter. We evaluated the effects of duration of SSRI use, cumulative dose, and latency on the risk of breast cancer by conducting a population-based case-control study utilizing Saskatchewan health databases.