Age, alcohol consumption, and all-cause mortality

PURPOSE: Numerous epidemiological studies on middle aged men suggest that moderate alcohol consumption lowers all-cause mortality. Uncertainty exists whether this finding also applies to younger adults. METHODS: The authors studied the age specific association between alcohol consumption and all-cause mortality in a cohort of 19,943 male employees in the German construction industry (age range 25-64 years) who underwent an occupational health examination between 1986 and 1992 and were followed with respect to vital status over an average period of 10 years. Information on alcohol consumption at baseline examination relied on self report and strongly correlated with biological markers of alcohol consumption. Covariates considered in the proportional hazard regression analysis included age, nationality, smoking status, and comorbidity. RESULTS: Age specific analysis revealed that the J/U-shaped association between alcohol consumption and all-cause mortality is limited to men aged 35 years and above. In contrast, a linear positive dose-response relationship was observed for men aged 25 to 34 years (p-trend=0.02). CONCLUSIONS: Recommendations regarding alcohol consumption and potential health benefits should not be generalized to all ages.     

The effect of CYP19 and COMT polymorphisms on exercise-induced fat loss in postmenopausal women

OBJECTIVE: To examine whether genetic polymorphisms in CYP19 [intron 4 (TTTA)n; n = 7 to 13 and a 3-base pair deletion, which is in strong linkage disequilibrium with the seven repeat] and COMT (Val108/158Met) modified the change in BMI, total and percentage body fat, or subcutaneous and intra-abdominal fat during a year-long exercise intervention trial. These genes metabolize estrogens and androgens, which are important in body fat regulation. RESEARCH METHODS AND PROCEDURES: A randomized intervention trial was used, with an intervention goal of 225 min/wk of moderate-intensity exercise for one year. Participants (n = 173) were postmenopausal, 50 to 75 years old, sedentary, overweight or obese, and not taking hormone therapy at baseline. RESULTS: Exercisers with two vs. no CYP19 11-repeat alleles had a larger decrease in total fat (-3.1 kg vs. -0.5 kg, respectively, p = 0.01) and percentage body fat (-2.4% vs. -0.6%, respectively, p = 0.001). Exercisers with the COMT Met/Met vs. Val/Val genotype had a smaller decrease in percentage fat (-0.7% vs. -1.9%, respectively, p = 0.05). Among exercisers, women with the COMT Val/Val genotype and at least one copy of the CYP19 11-repeat allele vs. those with neither genotype/allele had a significantly larger decrease in BMI (-1.0 vs. +0.1 kg/m2, respectively, p = 0.009), total fat (-2.9 vs. -0.5 kg, respectively, p = 0.004), and percentage body fat (-2.6% vs. -0.4%, respectively, p < 0.001). DISCUSSION: Genetic polymorphisms in CYP19 and COMT may be important for body fat regulation and possibly modify the effect of exercise on fat loss in postmenopausal women.     

Immunohistochemical study in dural arteriovenous fistula and possible role of ephrin-B2 for development of dural arteriovenous fistula

Background Although there were several clinical and experimental studies discussing the pathogenesis of dural arteriovenous fistula (DAVF), the pathological process leading to intracranial DAVF so far remains unknown. In this study, we investigated the expression of vascular growth factors in order to elucidate the possible role of these factors for the development of DAVF and to study the biological activity of this uncommon lesion.Methods We examined the histological features, proliferative and angiogenic capacities of the tissue specimens obtained from 6 patients who underwent surgery at our institution. Immunohistochemical staining for vascular endothelial growth factor (VEGF), its receptors FIk-1 and Fit-1, ephrin-B2, MIB-1 and proliferating cell nuclear antigen (PCNA) was performed using standard immunohistochemical techniques.Results A positive immunostaining was found for all antibodies studied except MIB-1, whereas nuclear endothelial expression of PCNA was observed in only 3/6 cases. VEGF stained positive in all of the available specimens (6/6). FIk-1 showed a positive immunoreaction in only 2/6 cases and Fit-1 in 4/6 cases. Ephrin-B2 was expressed in the majority (5/6) of the cases.Conclusions These results support the hypothesis that DAVFs might be acquired dynamic vascular malformations with low biological activity. Vascular growth factors like VEGF and ephrin-B2 might play a pivotal role in the formation of DAVF.     

己酮可可碱对外源性过敏性肺泡炎治疗作用的初步研究

目的　通过研究己酮可可碱 (POF)对外源性过敏性肺泡炎 (EAA)患者肺泡巨噬细胞(AM)产生的细胞因子的作用 ,探讨其治疗EAA的可能性 ,并与地塞米松 (DEX)的作用进行比较。方法　入选EAA患者 9例 ,通过支气管肺泡灌洗收AM ,并以 10 %RPMI为培养液或 10 %RPMI加内毒素 (LPS ,10 0 μg/L) ;或分别加入浓度为 0 0 1mmol/L、0 1mmol/L、1mmol/L的POF ;或加入 0 1mmol/LDEX进行AM培养 2 4h。用ELISA方法测定培养上清液中细胞因子含量。结果　POF可抑制EAA患者AM自发释放的TNFα和IL 10 ,此作用有剂量依赖关系 (P <0 0 0 1和P <0 0 5 )。POF对其他自发释放的细胞因子则无影响。 0 1mmol/LDEX只抑制自发释放的TNFα(P <0 0 5 )。除IL 1β和可溶性肿瘤坏死因子受体外 ,POF和 0 1mmol/LDEX均抑制LPS刺激的其他细胞因子的释放 (P <0 0 0 1或P <0 0 1或P <0 0 5 )。结论　POF对EAA的炎症有一定的抑制作用 ,然而POF治疗EAA及其他肺部疾病的临床价值 ,需要进一步的临床试验来评价。     

German-Austrian recommendations for HIV-therapy in pregnancy: update May 2003

In Germany during the past years about 200-250 HIV infected pregnant women delivered a baby per year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV was reduced to 1-2%. - This low transmission rate has been achieved by the combination of anti-retroviral treatment of pregnant women, elective caesarean section before onset of labor, anti-retroviral post exposition prophylaxis in the newborn and refraining from breast-feeding by the HIV infected mother. To keep pace with new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV infected adults, in 1998 and 2001 an interdisciplinary consensus meeting was held. Gynaecologists, infectious disease specialists, pediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO) were participating in this conference to update the prevention strategies. A third update became necessary in 2003. The updating process was started in January 2003 and was terminated in July 2003. The guidelines provide new recommendations on the indication and the starting point for HIV-therapy in pregnancies without complications, drugs and drug combinations to be used preferably in these pregnancies and updated information on adverse effects of anti-retroviral drugs. Also the procedures for different scenarios and risk constellations in pregnancy have been specified again. - With these current guidelines in Germany and Austria the low rate of vertical HIV-transmission should be further maintained or even further lowered.     

Low-dose sirolimus in combination with mycophenolate mofetil improves kidney graft function late after renal transplantation and suggests pharmacokinetic interaction of both immunosuppressive drugs

AIMS: Chronic allograft nephropathy and/or calcineurin inhibitor toxicity are common problems after organ transplantation. The aim of this study was to examine the safety and efficacy of switching from a calcineurin inhibitor-based to a calcineurin inhibitor-free immunosuppressive regimen consisting of sirolimus and mycophenolate mofetil (MMF) late after renal transplantation. METHODS: Kidney biopsies were performed in renal-transplanted patients with increasing serum creatinine levels at least 6 months after transplantation (mean time +/- SD after renal transplantation: 76.4 +/- 50.4 months). Patients with no signs of acute rejection were switched to MMF (500-2,000 mg/day) in combination with a low dose of sirolimus (1 mg/day). Renal function, serum chemistry, blood trough levels of sirolimus and MMF, and blood pressure were monitored. RESULTS: 13 patients were investigated. During our observation period (mean observation time +/- SD: 11.2 +/- 5.9 months), an improvement in renal function was observed in 10/13 patients. In 3/13 patients, renal function deteriorated further and hemodialysis was initiated in 2 patients within the next 6 months. However, a serum creatinine concentration above 3.5 mg/dl was measured in 2 of those 3 patients prior to the switch of the immunosuppressive protocol. Administration of a low dosis of sirolimus (1 mg/day) led to relevant sirolimus (4.16 +/- 1.85 ng/ml) and MMF blood trough levels (month 1: 6.8 +/- 3.46; month 3: 4.67 +/- 1.78 mg/l). The following adverse events were observed: borderline acute rejection (1/11 patients), anemia responding to higher dosage of erythropoietin (3/11), hyperlipidemia (1/11), and urinary tract infections (4/11). CONCLUSIONS: Low-dose sirolimus therapy in combination with concentration-adjusted MMF therapy leads to improvement of organ function late after renal transplantation. The follow-up of those patients should include assessments of blood cell counts, serum lipids and urinalysis to recognize the possible side effects.