Differences in the association of PAI-1 activity with the metabolic syndrome between African and Caucasian women

Background and aimsThe association between PAI-1_act and markers of the metabolic syndrome is well established in Caucasian populations, but data on African subjects is lacking. The aim of this study was to investigate possible differences between the association of PAI-1_act and markers of the metabolic syndrome in Caucasian and African women.Methods and resultsCross-sectional data were collected from 95 African and 114 Caucasian women in the Potchefstroom district of the North West Province, South Africa. Plasma PAI-1_act was almost twice as high in Caucasians compared to Africans (10.2 versus 5.2 U/mL, p < 0.001). Correlations between markers of the metabolic syndrome and PAI-1_act were remarkably stronger in Caucasians than in Africans. In multivariate regression analyses 56% of the variance of PAI-1_act could be explained by metabolic syndrome variables in the Caucasian group compared to 12% in the African women. Waist circumference was the strongest independent predictor of PAI-1_act in both groups.ConclusionThis study showed lower PAI-1_act in African than in Caucasian women, along with less associations of PAI-1_act with markers of the metabolic syndrome in the African than in the Caucasian women. The role of PAI-1_act in the metabolic syndrome may be less prominent in Africans than in Caucasians.     

Will torcetrapib be the next big thing in coronary heart disease risk reduction?

Scientists are seeking ways to increase high-density lipoprotein (HDL) cholesterol to lower coronary heart disease (CHD). Emerging from this search is torcetrapib, a partial inhibitor of cholesteryl ester transfer protein. Via this mechanism, cholesteryl ester is prevented from being transferred to apolipoprotein B-containing lipoproteins and is retained in HDL particles, where ostensibly it may be delivered directly to the liver for elimination. Proof that this may reduce atherosclerotic vascular disease is provided by population studies of cholesteryl ester transfer protein (CETP) deficiencies and single nucleotide polymorphisms of CETP, and experiments in animal models treated with torcetrapib. Torcetrapib effectively raises HDL cholesterol when used alone and when added to background therapy with atorvastatin. The drug appears to be well tolerated. Large surrogate and survival outcome trials are underway to document its impact on CHD.     

Elevated serum cardiac markers predict coronary artery disease in patients with a history of heart failure who present with chest pain: insights from the i*trACS registry

The significance of a history of heart failure (HF) in patients presenting with acute coronary syndromes and elevated cardiac markers is unclear. The authors performed an analysis of patients enrolled in the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS). Cardiac marker measurement and cardiac catheterization were performed in 1174 patients. Of these, 116 (9.9%) had heart failure (HF). Coronary artery disease (CAD) was found in 61 (52.6%) patients in the HF group and 581 (54.9%) in the group without HF. In the non-HF cohort, positive markers occurred in 306 patients, in whom 217 (70.9%) had CAD at catheterization. In the HF subset, 24 patients had positive biomarkers and 15 (62.5%) had CAD. A history of HF did not lessen the likelihood of CAD as evidenced by angiography and does not diminish the utility of cardiac markers in diagnosing acute coronary syndromes.     

The effects of selected probiotic strains on the development of eczema (the PandA study)

Background:  Modification of the intestinal microbiota by administration of probiotic bacteria may be a potential approach to prevent allergic disease. We aimed to study primary prevention of allergic disease in high-risk children by pre- and postnatal supplementation of selected probiotic bacteria.
Methods:  In a double-blind, randomized, placebo-controlled trial, a mixture of probiotic bacteria selected by in-vitro experiments ( Bifidobacterium bifidum, Bifidobacterium lactis, and Lactococcus lactis ; Ecologic^® Panda) was prenatally administered to mothers of high-risk children (i.e. positive family history of allergic disease) and to their offspring for the first 12 months of life.
Results:  Parental-reported eczema during the first 3 months of life was significantly lower in the intervention group compared with placebo, 6/50 vs 15/52 ( P  = 0.035). After 3 months, the incidence of eczema was similar in both groups. Cumulative incidence of parental-reported eczema at 1 and 2 years was 23/50 (intervention) vs 31/48 (placebo) and 27 (intervention) vs 34 (placebo), respectively. The number needed to treat was 5.9 at age 3 and 12 months and 6.7 at age 2 years. The intervention group was significantly more frequently colonized with higher numbers of Lc. lactis. Furthermore, at age 3 months, in vitro production of IL-5 (146 pg/ml vs 72 pg/ml; P  = 0.04) was decreased in the probiotic-group compared with the placebo-group.
Conclusions:  This particular combination of probiotic bacteria shows a preventive effect on the incidence of eczema in high-risk children, which seems to be sustained during the first 2 years of life. In addition to previous studies, the preventive effect appears to be established within the first 3 months of life.     

A review of similarities between domain-specific determinants of four health behaviors among adolescents

Schools are overloaded with health promotion programs that, altogether, focus on a broad array of behavioral domains, including substance abuse, sexuality and nutrition. Although the specific content of programs varies according to the domain focus, programs usually address similar concepts: knowledge, attitudinal beliefs, social influences and skills. This apparent conceptual overlap between behaviors and programs provides opportunities for a transfer-oriented approach which will stimulate students to apply the knowledge and skills they have learned in one domain (e.g. skills for resisting tobacco use) to other domains (e.g. alcohol, sex). A requirement for such an approach is that behaviors share at least some determinants. This review addresses this issue by examining similarities between domain-specific determinants of smoking, drinking, safe sex and healthy nutrition among adolescents. Recent empirical studies and reviews were examined. The results show that the following determinants are relevant to all four behaviors: beliefs about immediate gratification and social advantages, peer norms, peer and parental modeling and refusal self-efficacy. Several other determinants have been found to relate to at least two behaviors, e.g. health risk beliefs and parental norms. These results can be used for the development of a transfer-oriented school health promotion curriculum.     

Prognosis and Determinants of Outcome Following Locoregional or Distant Recurrence in Patients with Cutaneous Melanoma

Objective Information on prognosis for patients with cutaneous melanoma after locoregional or distant recurrence is sparse and controversial. The aim of this study was to analyze factors influencing outcome after the development of a first relapse. Methods Information was extracted from the Sydney Melanoma Unit database for 873 melanoma patients with American Joint Committee on Cancer (AJCC) Stage I and II disease treated between 1960 and 2002 who relapsed following treatment of their primary melanoma. Clinical and pathologic factors predicting survival were analyzed using the Cox proportional hazards regression model. Results Initial presentation of recurrence was local: 95 patients (10.9%), in transit: 86 patients (9.9%), regional lymph node: 300 patients (34.4%), and distant: 392 patients (44.9%). Independent prognostic factors for survival of the 481 patients with only locoregional recurrence were type of recurrence, primary tumor ulceration, and patient age. Predictors for longer survival in the 392 patients with distant metastasis at the time of first presentation with recurrence were lung vs other sites and diagnosis of relapse after 1990 compared with diagnosis before 1980. Conclusions The type of recurrence is the most important prognostic factor in melanoma patients who relapse. Primary tumor ulceration is the most important pathologic predictor. The results of this study suggest that management of distant metastases may have improved over the last 25 years, but many confounders and improved staging techniques make assessment of this unreliable.     

Regional radiotherapy versus an axillary lymph node dissection after lumpectomy: a safe alternative for an axillary lymph node dissection in a clinically uninvolved axilla in breast cancer. A case control study with 10 years follow up

Background

To correlate the metabolic changes with size changes for tumor response by concomitant PET-CT evaluation of lung cancers after radiotherapy.

Methods

36 patients were studied pre- and post-radiotherapy with¹⁸FDG PET-CT scans at a median interval of 71 days. All of the patients were followed clinically and radiographically after a mean period of 342 days for assessment of local control or failure rates. Change in size (sum of maximum orthogonal diameters) was correlated with that of maximum standard uptake value (SUV) of the primary lung cancer before and after conventional radiotherapy.

Results

There was a significant reduction in both SUV and size of the primary cancer after radiotherapy (p < 0.00005). Among the 20 surviving patients, the sensitivity, specificity, and accuracy using PET (SUV) were 94%, 50%, 90% respectively and the corresponding values using and CT (size criteria) were 67%, 50%, and 65% respectively. The metabolic change (SUV) was highly correlated with the change in size by a quadratic function. In addition, the mean percentage metabolic change was significantly larger than that of size change (62.3 ± 32.7% vs 47.1 ± 26.1% respectively, p = 0.03)

Conclusion

Correlating and incorporating metabolic change by PET into size change by concomitant CT is more sensitive in assessing therapeutic response than CT alone.     

The use of adjunctive anticoagulants in patients with acute coronary syndrome transitioning to percutaneous coronary intervention

Patients presenting to the Emergency Department (ED) need to be quickly diagnosed, risk-stratified, and treated accordingly. Anticoagulants used in the ED should be easy to use and suitable for all patients with acute coronary syndromes, regardless of treatment strategy. In patients with ST-segment myocardial infarction, current guidelines recommend unfractionated heparin regardless of reperfusion strategy or low-molecular-weight heparin (LMWH) as an alternative in patients undergoing percutaneous coronary intervention (PCI). The LMWH enoxaparin is approved for ST-segment elevation myocardial infarction patients managed medically or undergoing PCI. The recently updated American College of Cardiology/American Heart Association guidelines for patients with unstable angina or non-ST-segment elevation myocardial infarction recommend unfractionated heparin or the LMWH enoxaparin (class IA recommendation), or the factor Xa inhibitor fondaparinux or the direct thrombin inhibitor bivalirudin (class IB recommendation) for patients managed invasively. This review discusses each of these anticoagulant options in the context of patients transitioning to PCI.