Socioeconomic differences in cardiovascular risk factors in China

Socioeconomic conditions are important in explaining variation in cardiovascular morbidity in advanced societies. To analyse whether cardiovascular risk factors vary according to socioeconomic status in a developing country, and more specifically, in an urban area of China, we compared data from structured interviews and cardiovascular screenings in a group of 1169 male workers (45-65 years). These men participated in the five-year follow-up of a prospective investigation started in 1982/83 in several plants in Wuhan. Unhealthy behaviours such as heavy cigarette smoking and alcohol consumption were significantly more prevalent among men with low educational attainment and with jobs characterized by heavy physical workload, noise and heat. Men paid according to a new, highly demanding salary system exhibited significant increases in total cholesterol and systolic blood pressure from first to second screening. In conclusion, our findings show significant socioeconomic variation in cardiovascular risk factors among middle-aged male workers in China.     

Oxidative stress during dialysis: effect on free radical scavenging enzyme (FRSE) activities and glutathione (GSH) concentration in granulocytes

Background. Living cells are protected by free radical scavenging enzymes against oxygen radical-mediated damage. It has been suggested that granulocytes are activated on the surface of dialyser membranes, resulting in the generation of free radicals. We have recently reported a lack of plasma lipid peroxidation and unchanged glutathione peroxidase (GSH-Px) as well as glutathione reductase (GSSG-R) activities in red blood cells of haemodialysis patients. However, because mature red cells are free of DNA and RNA, free radical scavenging enzymes (FRSE) cannot be regulated on the gene level in response to an acute oxidative stress. In contrast to erythrocytes, granulocytes are nucleated cells and FRSE protein concentrations can therefore be modulated. Methods. GSH-Px, GSSG-R, superoxide dismutase (SOD) activities and total glutathione (GSH) were determined spectrophotometrically using a Cobas Fara semi-automatic analyser in granulocytes of 31 healthy blood donors and in 28 patients with chronic renal failure (CRF) for more than 6 months before as well as immediately after a single dialysis treatment. Patients were treated either by haemodialysis (n=17) using low-flux polysulphone membranes or by haemofiltration (n=11) using high-flux polysulphone membranes. Results. Compared to healthy controls, SOD and GSSG-R activities were increased in granulocytes of HD and HF patients, GSH and GSH-Px were decreased before a single treatment. After dialysis SOD and GSH-PX activities were significantly induced by both HD and HF whereas GSSG-R activities and GSH were decreased. Conclusions. These results show that the enzymatic defence against oxygen radicals can be induced in granulocytes of patients undergoing regular dialysis treatment, whereas the non-enzymatic defence is compromised as shown by decreased GSH concentrations, both suggesting increased oxidative stress.     

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The role of diet and drugs in lowering serum cholesterol in the postmyocardial infarction patient

Summary Lipid disorders are the most important factors in the development of coronary heart disease (CHD). They need to be treated in primary as well as in secondary prevention. U.S. and European Consensus Conferences a greed that desirable serum cholesterol levels should not exceed 200 mg/dL. When baseline cholesterol averages above 250 mg/dL, the minimum requirement for characterizing the lipoprotein disorder is measurement of cholesterol, triglycerides, and high-density lipoprotein (HDL) in the fasting state. In selecting targets for serum lipid values, it may be taken into account that CHD incidence is lowest in persons with serum cholesterol below 180 mg/dL. Any kind of lipid-lowering therapy should be commenced with dietary treatment. If this is ineffective, drugs may be applied additionally. Possible causes of secondary hyperlipidemia should be excluded. There is no strict age limit for treatment but the subject's cardiovascular status should be examined carefully, especially in secondary prevention. The patient in whom extensive myocardial damage is the main arbiter of prognosis is unlikely to gain from strenuous efforts aimed at retarding progression of atheromata, the major causes of CHD. A simple classification distinguishes drugs with a predominant effect on hypercholesterolemia from those effective in endogenous hypertriglyceridemia but with a somewhat weaker cholesterol-lowering action. Using lipid-lowering drugs, their indications and side effects should be considered.     

Comparison of different protocols for DNA preparation and PCR for the detection of fungal pathogens in vitro

Although a large number of different PCR protocols for the detection of fungal DNA from clinical samples have been described, a generally recognised standardisation has not yet been developed. In a first step, we compared six different methods to isolate DNA under in vitro conditions from Aspergillus fumigatus, Candida albicans and Saccharomyces cerevisiae with respect to efficiency and expenditure of time. To this end, methods were tested that are based on both mechanical and enzymatic/thermic lysis. Thereby, enzymatic/thermic lysis were shown to be superior to mechanical lysis, although these methods of DNA isolation were more time consuming. The subsequent comparison of three different PCR protocols showed real-time PCR to be the most sensitive method.     

The effects of insulin glargine treatment and an educational programme on glycaemic control in type 2 diabetes patients in clinical practice

OBJECTIVE: This retrospective analysis was performed to establish the effect of initiating insulin glargine (LANTUS; sanofi-aventis, Paris, France), a once-daily basal insulin analogue, in combination with an educational programme on glycaemic control and body weight in sub-optimally controlled patients with Type 2 diabetes in clinical practice. RESEARCH DESIGN AND METHODS: We undertook a retrospective review of the medical records of 46 patients (mean age 61.5 +/- 8.6 years) with Type 2 diabetes. These patients had previously been treated with oral antidiabetic agents (OADs; n = 18) or insulin only (n = 28) and had then received insulin glargine in combination with OADs or prandial insulin, for 30 months. Records of metabolic control and body weight data were analysed at 9 and 30 months. Patients had taken part in a diabetes educational programme before initiation of insulin glargine and received continued physician consultations throughout. RESULTS: Following initiation of insulin glargine, patients showed a significant decrease in HbA1c from 8.14 +/- 1.7% to 7.18 +/- 0.9% at 30 months (p < 0.001). When the results were analysed by pre-treatment, patients pre-treated with OADs showed a reduction in HbA1c of 2.3% at 30 months (p < 0.001), while patients pre-treated with insulin only showed a decrease in HbA1c of 0.4% (p < 0.005). There was no significant change in body weight. No unexpected adverse events or episodes of severe hypoglycaemia (blood glucose < 40 mg/dL [< 2.2 mmol/L]) occurred. CONCLUSIONS: Insulin glargine in combination with educational support and close clinical supervision significantly improved metabolic control without significant weight change in patients with Type 2 diabetes in clinical practice over 30 months. Additional studies are required to establish if similar results can be obtained in a larger cohort of patients.     

Neue Ergebnisse der Alternsforschung unter besonderer Berücksichtigung der Arteriosklerose (Internistisches Referat)

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