Changes in cardiac troponin T measurements are associated with adverse cardiac events in patients with chronic kidney disease

The purpose of this study was to determine whether long-term and short-term changes in cardiac troponin T (cTnT) were associated with adverse cardiac events (ACEs) in patients with chronic kidney disease. Long-term changes were defined as changes in cTnT between ED visits, and short-term changes were defined as changes between 2 consecutive serial cTnT measurements within an ED visit. A retrospective chart review of patients with chronic kidney disease with suspected acute coronary syndromes presenting to the ED between December 1999 and November 2003 was conducted. The primary outcome variable was an ACE which was a composite endpoint consisting of a discharge diagnosis of acute myocardial infarction, unstable angina, revascularization, cardiac dysrhythmias, all-cause mortality, or congestive heart failure exacerbation. The primary predictor of ACE abstracted from the charts was the initial cTnT measured during each ED presentation. There were 90 patients with 397 visits enrolled in the study. Using a mixed-models analysis of variance, cTnT was higher in the ACE group than in the non-ACE group (difference in log cTnT = 0.054, 95% CI 0.006-0.101) after adjusting for age, race, sex, dialysis status, and smoking history. No other variables were found to be associated with cTnT. To evaluate the clinical significance of acute changes in cTnT, a secondary analysis was performed on 64 patients with an initial cTnT measurement above 0.10 ng/mL. For in-hospital and 30-day ACE, a short-term increase in cTnT of 0.11 ng/mL had a positive likelihood ratio of 13.3 and 11.9, respectively. Long-term and short-term increases in cTnT are associated with an ACE.     

Resolution of residual pleural disease according to time course in tuberculous pleurisy during and after the termination of antituberculosis medication

STUDY OBJECTIVES: To assess the resolution of pleural disease in patients with tuberculous pleurisy (TP) during and after antituberculosis medication. DESIGN: An observational, prospective, longitudinal study. SETTING: University-affiliated general hospital in Seoul, Korea. PATIENTS AND METHODS: Chest radiographs of 85 adult TP patients were followed up prospectively from diagnosis to 24 months after the start of medication. The extent of pleural disease, synonymous with the radiographic term, pleural opacity (PO), was evaluated at regular intervals according to a size scale. Additionally, following completion of 6 months of therapy, residual PO (RPO) was determined by either measurement of the widest width of the opacity, if loculated, or at the superior level of the hemidiaphragm. RESULTS: Seventy-seven patients had a PO graded > or = 2 at the initial presentation. At 6, 9, and 24 months, the number of patients with these grades declined. At these time periods, there were 14, 8, and 7 patients, respectively, remaining with this classification. RPO > 10 mm at 24 months was considered indicative of significant residual pleural disease. During the period after 6 months of antituberculosis medication, the number of patients with RPO > or = 10 mm declined from 43 patients at 6 months to 21 patients at 24 months. The presence of loculation on an initial chest decubitus view was associated with significant RPO at 24 months (p = 0.009). CONCLUSION: In TP patients, improvement of RPO often occurred even after completion of 6 months of antituberculosis medication up to 24 months. A loculated PO at initial presentation, but not initial PO size, was a predictor of significant RPO at 24 months.     

Transdermal delivery of amino acids and antioxidants enhance collagen synthesis: in vivo and in vitro studies

One of the most visible changes associated with the aging process in humans relates to a progressive thinning of the skin. This results from a decline in both collagen and glycosaminoglycans, as well as from changes in their chemical structure and 3-dimentional organization. Transdermal administration of antioxidants, a -lipoic acid (LA) (0.5%) and proanthocyanidin PA) (0.3%) in a standard cosmetic vehicle base formulation supplemented with 2% benzyl alcohol as a penetration enhancer, a mixture of essential amino acids (0.2%), significantly enhanced collagen synthesis and deposition. The amino acid mixture was designed to mimic serum concentrations, with supplemental methionine added to provide additional sulfur. The histological appearance of the skin of mature female rats treated in this fashion reflected the increased deposition of collagen in the dermis as well as a thickened epidermal layer. The changes do not seem to be mediated by TGF- ss or PDGF, two growth factors known to stimulate collagen synthesis. At lower concentrations, a -lipoic acid did not affect cell proliferation but at higher doses, while it had an inhibitory effect on (3)H-thimidine uptake, it did enhance collagen production. Pronanthocyanidin did not affect cell proliferation but significantly increased collagen synthesis by cultured fibroblasts.