Association of overall and abdominal obesity with coronary heart disease risk factors: comparison between urban and rural Indian men

The relationship of body mass index (BMI), conicity index (CI) and waist circumference to four coronary heart disease (CHD) risk factors (systolic and diastolic blood pressures, total cholesterol and high-density lipoprotein (HDL) cholesterol levels) was examined in urban (n = 110) and rural (n = 102) men aged > or = 20 years, drawn from the 'Reddy' population of Southern Andhra Pradesh, India. Using ANCOVA we found significant difference (< 0.01) for systolic blood pressure, total cholesterol and HDL cholesterol between the urban and rural samples. The Pearson's correlation coefficients suggest that BMI and waist circumference had significant relationships with most of the risk factors in both the populations. The CI did not significantly influence any of the risk factors in the urban population; however, in the rural population, CI did show a significant positive relationship with both of the blood pressures and with TC. Even after controlling for age, smoking and physical activity (partial correlations), the relations remained constant. In multiple linear regression, BMI showed significant positive association with systolic and diastolic blood pressures (<0.01) and HDL cholesterol (<0.05) in the rural population only. However, the Cl showed a significant association with HDL cholesterol, and waist circumference with total cholesterol and HDL cholesterol in the rural population. The results of the present study revealed that BMI and waist circumference had a greater influence on the CHD risk factors, and that the influence was more conspicuous in the rural sample. Comparing the association of abdominal obesity measures (CI and waist circumference) with CHD risk factors, waist circumference better correlated with most of the risk factors. Hence the present study suggests that BMI and waist circumference are better indicators of CHD risk factors. However, the importance of Cl has to be further studied in South Asian populations.     

C-reactive protein and interleukin-6 levels are related to renal function in predialytic chronic renal failure

BACKGROUND: Several studies have provided convincing evidence that in apparently healthy subjects elevated serum levels of plasma C-reactive protein (CRP) are associated with an increased risk of experiencing myocardial infarction and sudden cardiac death. It has been claimed that, in dialytic patients, the hepatic synthesis of this 'acute phase response' plasma protein is primarily induced by the macrophage-derived interleukin 6 (IL-6). Little information is available, however, regarding CRP and IL-6 plasma levels in pre-dialytic renal failure. METHODS: Plasma CRP by a modification of the laser nephelometry technique, IL-6 and serum albumin were determined in 103 chronic pre-dialytic patients (mean age 50 +/- 6.3 years; creatinine clearance (Cr.cl.) 36.3 +/- 23.1 ml/min). RESULTS: CRP was >5 mg/l (normal upper range) in 42% of the global population. CRP and IL-6 were significantly related (r = 0.35, p < 0.0004). CRP and IL-6 were related to renal function (CRP vs. Cr.cl., r = -0.56, p < 0.0001; IL-6 vs. Cr.cl., r = -0.55, p < 0.0001, Spearman correlation coefficient). When patients were divided in tertiles according to renal function, CRP median value resulted 7.9 mg/l (interquartile interval: 5-12) in the first tertile (Cr.cl. <18.5 ml/min), 4.0 mg/l (3-6) in the second tertile (Cr.cl. 18.5-45 ml/min) and 3.2 mg/l (2.7-4.0) in the last tertile (Cr.cl. >45 ml/min) (p < 0.0001). A negative correlation between CRP and S-albumin was also found (r = -0.52, p < 0.0001, Spearman correlation coefficient). CONCLUSIONS: IL-6 and CRP were increased and were inversely related to creatinine clearance in our population of 103 chronic predialytic patients. The possibility of a decreased renal clearance of CRP and/or cytokines as a cause of an activated acute-phase response is discussed. A negative correlation between CRP and S-albumin was found confirming the link between chronic inflammation and malnutrition in chronic renal patients.     

Serum cholesterol levels and mood symptoms in the postpartum period

During pregnancy, the total serum cholesterol concentration rises up to 43%, followed by a rapid fall after delivery. Mild depressive symptoms ('postpartum blues') are a common complication of the puerperium and affect 30-85% of women in the early postpartum period. Based on these observations, it has been suggested that the sudden fall in cholesterol levels after delivery could serve as a 'natural model' to test the suggested association between cholesterol and mood. The present study was designed to expand the database concerning the association between cholesterol levels and mood in the postpartum period and to address some methodological problems raised by previous studies. Forty-seven healthy primiparous women were interviewed with a structured clinical interview on two occasions: during late pregnancy (median: day -20 before the expected delivery) and during the early postpartum period (median: day 32 after delivery). On both occasions, serum concentrations of total and HDL cholesterol were measured and mood symptoms were assessed with the state form of Spielberger's State-Trait Anxiety Index (STAI), the state form of the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). We found significant, albeit moderate, relationships between serum cholesterol levels and mood symptoms in the postpartum period that were not present during late pregnancy. Lower postpartum levels of total cholesterol were associated with symptoms of anxiety (r=-0.30, P=0.04), anger/hostility (r=-0.31, P=0.04), and depression (r=-0.35, P=0.02), and lower postpartum levels of HDL cholesterol were associated with symptoms of anxiety (r=-0.34, P=0.02). This study confirms that the physiological fall in blood lipids in the postpartum period can be a useful model to test the relationship between serum cholesterol levels and mood.     

反应停治疗难治性多发性骨髓瘤25例

1临床资料我院2001-02/2004-01接受2个疗程卡氮芥 环磷酰胺 马法兰 泼尼松 长春新碱或2个疗程长春新碱 阿霉素 地塞米松方案化疗无效或复发的难治性多发性骨髓瘤患者25(男16,女9)例,年龄42～80(中位年龄57.2)岁.单用反应停口服治疗,起始剂量200 mg/d,如无不良反应,每周增加100 mg,根据患者耐受情况,最高剂量为600 mg/d,3 mo为1疗程.服药期间禁止使用糖皮质激素类药物及细胞毒药物.     

Widening of the clinical spectrum of Bartonella henselae infection as recognized through serodiagnostics

The recently improved diagnostics have widened, in children, the spectrum of clinical manifestations recognisable as Bartonella henselae infection. We report here the clinical features of 20 (14 males) consecutive children with serologically proved B. henselae infection observed within 12 months in the Paediatric Department of the University of Pisa. The patients had a mean age of 7 years 4 months (range 1.1–14.1 years). All children but one had a history of contact with kittens. Clinical manifestations included regional lymphadenopathy in 14 patients, representing in five the only clinical manifestation at onset, infectious mononucleosis-like syndrome in six, erythema nodosum in three, and Parinaud oculoglandular syndrome in one. In five patients a severe disorder was first suspected: fever of unknown origin in two with multiple hepatosplenic granulomatosis in one; osteolityc lesion suggesting bone neoplasm, marked inguinal lymph-node enlargement, suggesting Burkitt lymphoma, and an acute encephalopathy in one each. Bartonella henselae IgG antibody was positive in all patients with a titre ranging from 1:128 to 1:8590. IgM antibody was present in all except one child with an IgG titre of 1:2048. All patients recovered, some spontaneously. Conclusion Bartonella henselae infection is frequent in Tuscany and probably underdiagnosed due to the high frequency of atypical onset of the clinical manifestations. An accurate clinical history and a reasonably wide use of the serological test may allow a rapid and accurate diagnosis, reassuring the family of the patient and avoiding invasive and expensive diagnostic procedures. Received: 14 June 1999 and in revised form 16 October 1999 / Accepted: 22 November 1999     

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background  

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.     

Methylthiomethyl,a new carboxyl protecting group in peptide synthesis

N^α-protected amino acid methylthiomethyl esters (MTM) were obtained in good yields under mild conditions using the «Bu^tBr/Me₂SO» reagent. Selective removal of the N-protecting group was achieved in HCl/anhydrous ethyl ether and the MTM ester hydrochlorides were successfully used in the synthesis of dipeptides.     

Power spectral analysis of the surface electromyogram of human jaw muscles during fatigue

Muscle fatigue in the anterior temporal and masseter muscles of 13 normal subjects was induced by maximum clench in intercuspal position. Frequency analysis using a fast Fourier transform algorithm to obtain the power-spectral density function and the power spectrum of the electromyogram signal indicated that the power spectra obtained during fatigue were statistically significantly shifted to lower frequencies and narrower than those obtained at the beginning of the clench. The shift was due to a significant increase of the power in the low-frequency range and a significant decrease of that in the high-frequency range. The power-spectrum shift to lower frequencies had an exponential time course. The most pronounced shift occurred in the first 25 per cent of the total clenching time. Decrease of the conduction velocity of the action potential along the muscle fibre seems to be the main cause of the shift.