Severe depression of high-density lipoprotein cholesterol levels in weight lifters and body builders by self-administered exogenous testosterone and anabolic-androgenic steroids

The effects of nonphysician prescribed, self-obtained, self-administered exogenous anabolic-androgenic steroids and testosterone on plasma total, high- and low-density lipoprotein cholesterol (HDLC, LDLC), and triglycerides were evaluated in 14 adult white men, 11 body builders and 3 power weight lifters. Lipids and lipoprotein cholesterols were quantified during active physical conditioning, both on (for at least 1 month, mean +/- SD 1.8 months) and off (for at least 4 months, 7.3 +/- 2.7 months) self-administered exogenous androgenic steroids. The subjects took 50 to 100 mg methandrostenolone daily plus weekly injections of testosterone 100 to 200 mg and nandrolone decanoate 100 to 200 mg per week. Mean (SD) HDLC on exogenous androgenic steroids, 29 +/- 8 mg/dL, was severely depressed, and was less than 50% of the consistently elevated mean HDLC when exogenous steroids were not used (61 +/- 14 mg/dL, P less than .01 for paired differences). During anabolic steroid use, HDLC was less than or equal to the age- race- and sex-specific 10th percentile in 11 of the 14 men, whereas while off anabolic steroids, HDLC was greater than or equal to the 90th percentile in 7 of the 13 men, and in the top quartile for 3 of the remaining 6 men. Mean LDLC was higher on androgenic steroids (150 +/- 44) than off (125 +/- 38 mg/dL), P less than .05 for paired differences. The ratio of LDLC/HDLC during exogenous steroid use (6.0 +/- 3.7) was nearly triple the ratio obtained when steroids were not taken (2.2 +/- 1.0), P less than .01 for paired differences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of supine and erect bicycle exercise electrocardiography in coronary heart disease: Accentuation of exercise-induced ischemic ST depression by supine posture

Exercise-induced electrocardiographic ST depression was compared during supine and erect graded bicycle exercise in 43 patients with chest pain but no prior myocardial infarct; all had ≥1 mm of ST depression during either erect or supine exercise; 16 had multivessel, 24 had 1-vessel and 3 had no coronary artery disease. Supine exercise used 4 minutes/stage and erect exercise used either 4 minutes or 3 minutes/stage with identical graded work loads for both postures. Chest pain occurred in 31 patients during erect and in 29 during supine exercise. ST depression was ≥1 mm in 28 patients during erect exercise and in all 43 during supine exercise (p <0.001); mean maximal ST depression was 1.3 ± 0.2 mm during erect and 2.6 ± 0.2 mm during supine exercise (p <0.001). Maximal work load was higher during erect than supine exercise (745 ± 32 versus 678 ± 32 kpm/min; p <0.001). The accentuation of ST depression by supine posture was not attributable to the changes in heart rate, rate-pressure product or mean blood pressure during supine versus erect exercise. In the 10 patients who had 2 erect bicycle tests using work load durations of 3 and 4 minutes, the maximal ST depression was not significantly different (erect 3 minutes 1.3 ± 0.5 mm and erect 4 minutes 1.4 ± 0.4 mm). In 7 patients who also had a maximal treadmill exercise test, the maximal ST depression was significantly greater during supine exercise (2.3 ± 0.4 mm) than during either an erect bicycle test (0.6 ± 0.4 mm) or treadmill exercise (0.7 ± 0.4 mm) (p <0.05). Supine posture should be considered as an important potentiator of exercise-induced myocardial ischemia whem comparing indicators such as electrocardiography, radionuclide ventriculography and thallium-201 myocardial perfusion imaging during exercise.     

Noninvasive assessment of left ventricular performance following transluminal coronary angioplasty

We studied 36 patients with successful transluminal coronary angioplasty (group 1) noninvasively using exercise electrocardiography, exercise T1-201 myocardial scintigraphy and equilibrium radionuclide ventriculography before and 3-5 days after the procedure. Six patients who underwent aortocoronary-bypass surgery (group 2) and 10 patients with stable angina pectoris (group 3) served as controls. All patients had arteriographically documented coronary artery disease at least in one major coronary vessel (stenosis greater than or equal to 70%). In group 1, average coronary stenosis was 81.1 +/- 8.4% before dilatation and 44 +/- 13.7% after the procedure (P less than 0.001). Ischemia score in the exercise electrocardiography decreased from 2.4 +/- 2.7 before dilatation to 0.4 +/- 0.8 after the procedure (P less than 0.001). Myocardial perfusion in computerized T1-201 myocardial scintigraphy 5-10 min after exercise expressed as vitality index (the ratio of T1-201 uptake in the ischemic region to the region of maximal uptake in the same image analyzed carefully in the same view in 2 studies) increased from 72.9 +/- 8.4% before dilatation to 79.9 +/- 11.7% after the procedure (P less than 0.001). Ejection fraction at rest increased from 47.2 +/- 9.2% to 51.0 +/- 9.7% (P less than 0.001) and during exercise from 39.9 +/- 10.5% to 49.4 +/- 10.9% (P less than 0.001) before and after the procedure. In group 2, noninvasive studies showed a tendency to improvement after surgery. In group 3 no significant changes were noted. We conclude that transluminal coronary angioplasty improves both coronary perfusion to ischemic areas supplied by critical coronary artery stenoses and left ventricular function, especially during exercise, if luminal diameter is dilated by greater than 20%.     

The differential dependence of abstract and concrete words upon associative and similarity-based information: Complementary semantic interference and facilitation effects

We report mirror-image effects of interference and facilitation in the semantic processing of identical sets of abstract and concrete words in a patient F.B.I. with global aphasia following a large left middle cerebral artery stroke. Interference was elicited when the tasks involved comprehending the spoken form of each word, but facilitation was found when the patient read aloud the written forms of the same words. More importantly, irrespective of whether the dynamic effect was one of facilitation or interference, effects of semantic association were observed for abstract words, whilst effects primarily of semantic similarity were observed for concrete words. These results offer further neuropsychological evidence that the more abstract a word, the greater its dependence upon associative information and the smaller its dependence upon similarity-based information. The investigations also contribute to a converging body of evidence that suggests that this theory generalizes across different experimental paradigms, stimuli, and participants and also across different cognitive processes within individual patients. The data support a graded rather than binary or ungraded model of the relationships between concreteness, association, and similarity, and the basis for concrete words’ greater dependence upon similarity-based information is discussed in terms of the development of taxonomic structures and categorical thought in young children.     

The Effect of l‐Arginine on Porphyromonas gingivalis‐Induced Phagocytosis of a Murine Macrophage‐like Raw 264.7 Cell Line

The aim of this study was to determine the effect of l‐arginine on Porphyromonas gingivalis‐induced phagocytosis by RAW 264.7 cells. The cells were pretreated with l‐arginine or d‐arginine prior to incubation with either unopsonized or opsonized P. gingivalis. In other experiments, the cells were pretreated with l‐arginine and various concentrations of NMLA (N^G‐monomethyl‐l‐arginine) prior to incubation with the bacteria. The phagocytosis was microscopically assessed and determined by the phagocytic index. The results showed that l‐arginine, but not d‐arginine enhances the ability of RAW264.7 cells to engulf the bacteria. The upregulatory effect of l‐arginine on P. gingivalis‐induced phagocytosis was abolished by NMLA. The results of the present study suggest that l‐arginine may upregulate the P. gingivalis‐induced phagocytic activity of RAW264.7 cells, perhaps, via modulation of nitric oxide synthase.     

The Effect of Poly(d,l-Lactide-co-Glycolide)-Alendronate Conjugate Nanoparticles on Human Osteoclast Precursors

Abstract

Nanoparticles (NPs) formed from polymers conjugated with bisphosphonates (BPs) allow the bone targeting of loaded drugs, such as doxorubicin, for the treatment of skeletal tumours. The additional antiosteoclastic effect of the conjugated BP could contribute to the inhibition of tumour-associated bone degradation. With this aim, we have produced NPs made of poly(d,l-lactide-co-glycolide) (PLGA) conjugated with alendronate (ALE). To show if ALE retained the antiosteoclastic properties after the conjugation with PLGA and the production of NPs, we treated human osteoclasts, derived from circulating precursors, with PLGA–ALE NPs and compared the effects on actin ring generation, apoptosis and type-I collagen degradation with those of free ALE and with NPs made of pure PLGA. PLGA–ALE NPs disrupted actin ring, induced apoptosis and inhibited collagen degradation. Unexpectedly, also NPs made of pure PLGA showed similar effects. Therefore, we cannot exclude that in addition to the observed antiosteoclastic activity dependent on ALE in PLGA–ALE NPs, there was also an effect due to pure PLGA. Still, as PLGA–ALE NPs are intended for the loading with drugs for the treatment of osteolytic bone metastases, the additional antiosteoclastic effect of PLGA–ALE NPs, and even of PLGA, may contribute to the inhibition of the disease-associated bone degradation.     

Informing patients about medicines—A hospital in-patient survey in England

Objective

To determine the frequency with which hospital in-patients receive information about medicines and whether this varies dependent on patient characteristics or hospitals.

Methods

Cross-sectional survey of medical in-patients in six hospitals in North West England.

Results

1218 questionnaires were completed sufficiently for analysis by medical in-patients. 534 (43.9%) respondents were informed fully about their medicines by a hospital doctor, nurse or pharmacist and 411 (33.9%) partly informed, but 272 (22.49%) had received no information or could not recall any. Fewer than 20% had received written medicines information. The majority of respondents (763; 62.6%) were not asked if they had any concerns or could not recall this. Patient factors including age, educational level and number of medicines taken did not influence whether or not medicines information was provided, but there were differences between hospitals.

Conclusion

There is considerable variation between hospitals in the frequency with which patients are given verbal and written information about medicines and are asked about any medicine-related concerns.

Practice implications

Informing patients about medicines while in hospital needs to be improved. Doctors, nurses and pharmacists all need to accept and co-ordinate responsibility for informing patients about medicines and asking if they have any concerns or questions.