Correlation of clinical profiles with obstructive sleep apnea and metabolic syndrome

Background  

Obstructive sleep apnea (OSA) is a common condition being increasingly recognized and is associated with many diseases. Few data are available for Indian patients and public health hazard of the condition continues to be seriously underestimated in this country. The objective of this study was to evaluate the prevalence of obesity, hypertension, diabetes mellitus, and hyperlipidemia (HLP) in a South Indian population with proven OSA.     

Arterial stiffness response to exercise in persons with and without Down syndrome

This study compared arterial stiffness and wave reflection at rest and following maximal exercise between individuals with and without Down syndrome (DS), and the influence of body mass index (BMI), peak oxygen uptake (VO₂peak) on changes in arterial stiffness. Twelve people with DS (26.6 ± 2.6 yr) and 15 healthy controls (26.2 ± 0.6 yr) completed this study. Intima-media thickness (IMT) and stiffness of common carotid artery was examined. Hemodynamic and arterial variables were measured before and 3-min after exercise. Persons with DS had higher BMI and lower VO₂peak than controls. IMT did not differ between groups. At rest, carotid β stiffness was significantly higher in persons with DS (P < 0.05) but there was no difference in between groups for any of the other arterial stiffness measures. After exercise, persons with DS exhibited attenuated arterial stiffness responses in AIx-75, carotid β stiffness and Ep in contrast with controls (significant group-by-time interactions). When controlling for BMI and VO₂peak, the interactions disappeared. In both groups combined, BMI was correlated significantly with carotid Ep and β at rest. VO₂peak correlated significantly with AIx-75 and its pre-post change (r = ?0.45, P = 0.029; r = 0.47, P = 0.033, respectively). The arterial stiffness responses to maximal exercise in persons with DS were blunted, potentially reflecting diminished vascular reserve. Obesity and particularly VO₂peak influenced these findings. These results suggest impaired vascular function in people with DS.     

A systematic review and Number Needed to Treat analysis to guide the management of the neck in patients with squamous cell carcinoma of the head and neck

Objectives

To systematically review the literature to identify studies from which it is possible to perform a Number Needed to Treat (NNT) analysis to identify, in a more clinically intuitive manner, neck node levels for which treatment is essential in the N0 and N+ neck with respect to the primary site of tumour.

Methods

Systematic literature review using a defined search strategy; data extraction from studies meeting the inclusion criteria; calculation of NNT for individual neck node levels with respect to primary site.

Results

A total of 6169 articles were identified from searches of Embase, Medline, The Cochrane library of randomised control trials, conference proceedings and the bibliographies of retrieved papers. Titles and abstracts were screened; from these, 219 studies were retrieved for detailed review. One hundred and ninety six papers were excluded and 23 studies were included in the final analysis. Following review of the data from these studies, and accepting a NNT cut-off of 5 we confirmed that the following lymph node levels should be treated:

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  N0 neck: oral cavity levels II; larynx levels VI; oropharynx levels IIA; hypopharynx levels VI.

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  N+ neck: oral cavity insufficient data; larynx levels IIA − IV + VI; oropharynx levels IIA − III; hypopharynx levels IIA, IIB − IV + VI.

Conclusions

NNT is a clinically intuitive parameter to guide appropriate lymph node level treatment in patients presenting with squamous cell carcinoma of the head and neck.     

Effects of atorvastatin on vascular function, inflammation, and androgens in women with polycystic ovary syndrome: a double-blind, randomized, placebo-controlled trial

To determine the effects of statins on vascular function, inflammation, and androgen levels in women with polycystic ovary syndrome (PCOS), we randomized 20 women with PCOS who had low-density lipoprotein cholesterol levels >100 mg/dL to atorvastatin (40 mg/day) or placebo for 6 weeks and found that atorvastatin reduced androgen levels, biomarkers of inflammation, and blood pressure; increased insulin levels and brachial artery conductance during reactive hyperemia; and failed to improve brachial artery flow-mediated dilation. We conclude that until additional studies demonstrate a clear risk-to-benefit ratio favoring statin therapy in PCOS, statins should only be used in women with PCOS who meet current indications for statin treatment.     

Ruling out and ruling in neural codes

The subject of neural coding has generated much debate. A key issue is whether the nervous system uses coarse or fine coding. Each has different strengths and weaknesses and, therefore, different implications for how the brain computes. For example, the strength of coarse coding is that it is robust to fluctuations in spike arrival times; downstream neurons do not have to keep track of the details of the spike train. The weakness, though, is that individual cells cannot carry much information, so downstream neurons have to pool signals across cells and/or time to obtain enough information to represent the sensory world and guide behavior. In contrast, with fine coding, individual cells can carry much more information, but downstream neurons have to resolve spike train structure to obtain it. Here, we set up a strategy to determine which codes are viable, and we apply it to the retina as a model system. We recorded from all the retinal output cells an animal uses to solve a task, evaluated the cells' spike trains for as long as the animal evaluates them, and used optimal, i.e., Bayesian, decoding. This approach makes it possible to obtain an upper bound on the performance of codes and thus eliminate those that are insufficient, that is, those that cannot account for behavioral performance. Our results show that standard coarse coding (spike count coding) is insufficient; finer, more information-rich codes are necessary.     

The management of the obese diabetic patient

The prevalence of obesity and diabetes is increasing in the United States and worldwide. These diseases are predicted to explode to epidemic proportions, unless appropriate counteractive measures are taken. Several large studies (DCCT, UKPDS, Kumamoto) clearly showed that intensive glycemic control in the diabetic patient reduced microvascular complications and improved mortality. Despite this, the NHANES III showed that only 50% of diabetics have been able to achieve a HgbAic level that is less than 7%; this suggests the need for a re-evaluation of our approach to these patients. The management of the obese diabetic patient involves glycemic control and weight reduction. These goals are particularly difficult to achieve in the obese diabetic patient because progressive beta-cell dysfunction and increasing insulin resistance necessitates the administration of increasingly higher dosages of insulin, which, in turn, promotes weight gain. A vicious cycle may ensue. Lifestyle modifications with diet and exercise are an essential part of the management of the obese diabetic patient. These measures alone are often insufficient and concomitant pharmacologic therapy is usually required to achieve glycemic and weight control. Oral agents that improve glycemia, decrease insulin resistance, and limit weight gain are desirable. Because of the progressive nature of diabetes, glycemic control with monotherapy often deteriorates over time, which necessitates the addition of other pharmacologic agents, including insulin. When insulin therapy is required in the treatment of the obese diabetic patient, combinations with oral agents that have been shown to minimize the amount of exogenous insulin that is required, may minimize weight gain. In addition, the obese diabetic patient who is poorly controlled with maximum oral hypoglycemic therapy may benefit from weight-reducing agents, such as sibutramine or orlistat. The introduction of these agents at other points in the management of the obese diabetic patients have been successful. Finally, for the severely obese diabetic patient, bariatric surgery may be the only effective treatment. Gastric bypass has been unequivocally shown to produce significant weight loss and improve glycemic control on a long-term basis in the obese diabetic patient. It is recommended that physicians avail themselves of all of these strategies in the management of the obese patient who has type 2 diabetes.     

Combined lung-liver-pancreas transplantation in a recipient with cystic fibrosis

Cystic fibrosis (CF) affects multiple organs including the lung, liver, and pancreas. Lung transplant, liver transplant, and combined lung-liver transplant have become well-established therapies for CF patients with end-stage organ failure. Thus far, however, there has been limited experience with pancreas transplantation in CF. In this report, we detail the clinical history, transplant procedure, and post-operative recovery of a patient who underwent combined lung-liver-pancreas transplant for advanced CF.     

Protective strategies against ischemic injury of the liver

This article summarizes strategies to protect the liver from injuries caused by ischemia and reperfusion. Three different sections (i.e., surgical and pharmacologic strategies and gene therapy) present approaches to enhance the survival and viability of the liver in various surgical procedures including liver transplantation. The first section reviews approaches using surgical interventions such as ischemic preconditioning and intermittent clamping. Their protective effects are discussed with respect to the mechanism of injury. In the second section, pharmacologic agents targeting microcirculation, oxidative stress, proteases, and inflammation are described. Mechanisms of injury and their suppression by a wide variety of drugs are discussed. The third section focuses on gene therapy. Potential target genes have been identified (e.g., superoxide dismutase or heme oxygenase). Animal experiments in which the liver injury is reduced successfully may pave the way to novel strategies applied to different liver diseases in humans.     

<Emphasis Type="Italic">SERPINA1</Emphasis> Hepatocyte-Specific Promoter Polymorphism Associate with Chronic Obstructive Pulmonary Disease in a Study of Kashmiri Ancestry Individuals

Purpose

Different mutations in coding and non-coding sequences of the SERPINA1 gene have been implicated in the pathogenesis of COPD. However, ??10T/C mutation in the hepatocyte-directed promoter region has not been associated with COPD pathogenesis so far. Here, we report an increased frequency of ??10C genotype that is associated with decreased levels of serum alpha1-antitrypsin (α1AT) in COPD patients.

Methods

The quantification of serum α1AT was done by ELISA, the phenol–chloroform method was used for DNA extraction, PCR products were directly sequenced. The IBM SPSS Statistics v21 software was used for statistical analyses of the data.

Results

The mean serum α1AT level was found to be 1.203+0.239 and 3.162+0.160 g/L in COPD cases and in control, respectively. The ??10C allele is associated with an increased risk of COPD [OR, 3.50 (95%CI, 1.86-6.58); p < 0.001]. The combined variant genotype (TT+CC) was significantly found associated with an increased risk of COPD [OR, 3.20 (95% CI, 1.47-6.96); p = 0.003]. A significant association of the family history with COPD (overall p value= 0.0331) suggests that genetics may play an important role in the pathogenesis of COPD.

Conclusion

The polymorphism associated with hepatocyte-specific promoter region (??10T/C) is likely to be associated with the pathogenesis of COPD. It is quite possible that the change of the base in the hepatocyte-specific promoter of the SERPINA1 gene can modulate its strength, thereby driving the reduced expression of α1AT.