A 2-year, randomized, comparative, placebo-controlled study on the effects of raloxifene on lipoprotein(a) and homocysteine

OBJECTIVES: Lipoprotein(a) (Lp(a)) and homocysteine (Hcy) are independent cardiovascular risk factors, which have been shown to be lowered by hormone replacement therapy (HRT). In this 2-year study, the long-term effects of raloxifene (Rlx) in two doses, on Lp(a) and Hcy, were studied and compared with the effects of continuously combined hormone replacement therapy (ccHRT). METHODS: In a prospective, randomized, double-blind, placebo-controlled 2-year study, 95 healthy, non-hysterectomized, early postmenopausal women, received daily either oral Rlx 60 mg (N=24) or 150 mg (N=23), ccHRT (conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg; N=24) or placebo (N=24). Fasting serum Lp(a) and plasma Hcy concentrations were measured at baseline and at 6, 12 and 24 months. RESULTS: The mean individual changes compared to baseline after 24 months were for Lp(a): Rlx 60: - 5%, Rlx 150: -7%, ccHRT: -34%, placebo: +1% and for Hcy: Rlx 60: -3%, Rlx 150: -4%, ccHRT: -4%, placebo: +6%. ANCOVA was significant for Lp(a) under ccHRT versus placebo (P=0.001) and for Lp(a) under ccHRT versus each of the two Rlx groups (P<0.05). CONCLUSIONS: Long-term treatment with Rlx was not as effective as ccHRT in lowering Lp(a). Although not significant and without an obvious dose-related response, the Hcy values showed the same trend for each treatment arm, which is in line with data reported earlier.     

Effect of estrogen on intestinal strontium absorption in postmenopausal women

Objectives: there is considerable uncertainty about the underlying cause of decreased intestinal calcium absorption that occurs in postmenopausal women. In a previous study, estrogen treatment did not result in an increased intestinal calcium absorption using strontium as a marker. A possible explanation could be that the calcium/strontium load given to the women was too high (600 mg Ca), which might result in an insensitive test with respect to the possible stimulation of active strontium transport by estrogen. Therefore, the purpose of this study was to reinvestigate the effect of estrogen on active intestinal strontium absorption using a load of 2.5 mmol of strontium only. Methods: the effect of estrogen on intestinal strontium absorption was measured in eight normal postmenopausal women. The study included two baseline strontium absorption tests, which were performed with an interval of 10 days for calculating the within subject variation (SER). Thereafter the effect of 2 months of estrogen treatment on intestinal strontium absorption was assessed. Fractional absorption (FC₂₄₀) and the area under the concentration time curve (AUC) 4 h after an oral strontium load of 2.5 mmol were calculated. Results: the within subject SER of FC₂₄₀ and AUC^0-240 were 2.3±0.76 and 1.2±0.41, respectively. FC₂₄₀ and AUC^0-240 of strontium were unchanged after treatment with estrogen. Conclusions: in normal postmenopausal women, we did not find a modulating effect of short-term treatment with a (supra) physiological dose of estrogen on intestinal calcium absorption as measured by the strontium absorption test.     

Culturally sensitive assessment and treatment of eating disorders

Computer-based delivery of health-related psychoeducational programming is increasingly popular. In the present study, 72 non-symptomatic undergraduate women were randomized to an Internet-based prevention program for eating disorders with or without accompanying discussion groups, or a control group. Sixty-one of the women (84%) completed the Student Bodies program, and were assessed at short and eight–nine month follow-up. Participation in the program resulted in better outcomes across all groups compared to controls, and women in the unmoderated discussion group appeared to have the most reduction in risk. Benefits of the program continued at follow-up. Decrease in risk also was associated with time spent using the Internet-based program. The present study suggests that the use of Student Bodies may reduce risk of eating and body image concerns over the long term, and that moderation of discussion groups may not be essential for successful outcomes. Further research on larger samples will help determine the degree to which discussion groups or the Student Bodies program alone are effective.     

Experimental Study of Tensile Properties of Styrene–Butadiene–Styrene Modified Asphalt Binders

The requirements imposed on road pavements are ever increasing nowadays, necessitating the improvement of the properties of paving materials. The most commonly used paving materials include bituminous mixtures that are composed of aggregate grains bound by a bituminous binder. The properties of bitumens can be improved by modification with polymers. Among the copolymers used for modifying bitumens, styrene–butadiene–styrene, a thermoplastic elastomer, is the most commonly used. This article presents the results of tests conducted on bitumens modified with two types of styrene–butadiene–styrene copolymer (linear and radial). Two bitumen types of different penetration grades (35/50 and 160/220) were used in the experiments. The content of styrene–butadiene–styrene added to the bitumen varied between 1% and 6%. The results of the force ductility test showed that cohesion energy can be used for qualitative evaluation of the efficiency of modification of bitumen with styrene–butadiene–styrene copolymer. The determined values of the cohesion energy were subjected to the original analysis taking into account the three characteristic elongation zones of the tested binders. The performed analyses made it possible to find a parameter whose values correlate significantly with the content of styrene–butadiene–styrene copolymer in the modified bitumen. With smaller amounts of added modifier (approximately 2%), slightly better effects were obtained in the case of linear copolymer styrene–butadiene–styrene and for larger amounts of modifier (5–6%) radial copolymer styrene–butadiene–styrene was found to be more effective. This is confirmed by the changes in the binder structure, as indicated by the penetration index (PI).     

Comparison of defibrillation efficacy using implantable cardioverter-defibrillator with single- or dual-coil defibrillation leads and active can

INTRODUCTION: The reduction of defibrillation threshold (DFT) in patients treated with an implantable cardioverter-defibrillator increases patients' safety and prolongs ICD battery life. AIM: To evaluate the possibility of reducing the defibrillation threshold in ICDs with an active can and an additional atrial defibrillation coil instead of the typical intracardiac single-coil lead. METHOD: This study involved 138 patients (36 F and 102 M, mean age 54+/-15 years) including 62 subjects with dual-coil defibrillation lead (group A) and 76 ones with single-coil defibrillation lead (group B). No statistically significant differences with respect to age, left ventricular function, main disease or exacerbation of heart failure according to the NYHA functional class were observed between groups. The defibrillation threshold was measured using the DFT+ protocol. RESULTS: No significant differences between groups were identified with respect to pacing and sensing parameters. The comparison of DFT values between the two studied groups revealed significant improvement (by 14% mean) of defibrillation efficacy in group A. In group A, the mean DFT was 9.8+/-4.6 J (3-20 J) and mean defibrillation resistance - 45+/-7 W (32-73 W), whereas in group B: 11.45+/-5.25 J (3-28 J) and 72+/-12.8 W (38-106 W), respectively. In 93% of patients from group A, DFT was below 15 J, in comparison to 81% of patients from group B (p=0.046). The odds ratio of a higher defibrillation threshold (?15 J) in group A vs. group B was 0.3 (95% confidence interval: 0.09-0.98). The DFT reduction associated with modified ICD system use was independent of following clinical parameters: patient age, gender, main disease, end-diastolic left ventricular diameter, left ventricular ejection fraction, NYHA functional class and concomitant treatment with antiarrhythmic agents. CONCLUSIONS: Modification of the electric field during defibrillation, achieved with the use of active-can ICDs with dual-coil defibrillation leads, allows a reduction of DFT by 14%. At the same time, it reduces the risk of a higher (> or =15 J) DFT by three times compared to patients with a standard single-coil defibrillation lead.     

Raloxifene treatment increases plasma levels of beta-endorphin in postmenopausal women: a randomized,placebo-controlled study

Objective: To evaluate the effect of the selective estrogen receptor modulator raloxifene hydrochloride (Evista, Eli Lilly and Company, Indianapolis, IN) on plasma levels of β-endorphin, and to determine whether β-endorphin levels and menopausal symptoms are related.

Design: A randomized, double-blind, placebo-controlled pilot study.

Setting: Endocrinology outpatient department.

Patient(s): Forty postmenopausal women.

Intervention(s): The women received raloxifene, 60 mg/d, or placebo for 3 months. A questionnaire on climacteric symptoms was administered before and after treatment.

Main Outcome Measure(s): Circulating levels of β-endorphin, climacteric symptom score, and correlation with β-endorphin levels.

Result(s): Raloxifene treatment significantly increased levels of β-endorphin and did not significantly affect climacteric symptoms, with the exception of worsening vasomotor symptoms. No significant relation was seen between plasma levels of β-endorphin and climacteric symptoms.

Conclusion(s): Raloxifene modulates plasma levels of β-endorphin without concomitantly relieving climacteric symptoms, as seen with hormone replacement therapy.     

Shortening the second phase duration of biphasic shocks: effects of class III antiarrhythmic drugs on defibrillation efficacy in humans

INTRODUCTION: The specific waveform providing optimal defibrillation threshold (DFT) is unknown. We compared the defibrillation efficacy of biphasic pulses with second phases (P2) of 2 and 5 msec in a randomized prospective clinical study. METHODS AND RESULTS: Intraoperative DFTs of 62 patients (age 54 +/- 13 years; ejection fraction 43% +/- 17%; amiodarone 47%, d,l-sotalol 13%) were determined in random order using a binary search protocol. Anodal shocks of 60% tilt first phases (P1) and P2 of 2 msec/5 msec were delivered from two 100-microF capacitors between the right ventricular electrode and the test housing of a Phylax 06/XM device. Mean DFT was significantly lower using the shorter P2 (9.5 +/- 4.5 J vs 11.3 +/- 5.2 J; P < 0.0001). According to subgroup analysis, the effect of changing P2 duration was only influenced by antiarrhythmic treatment. DFT decreased markedly using the shorter P2 in patients treated with amiodarone (10.7 +/- 4.9 J vs 13.4 +/- 5.6 J; P < 0.00001) or d,l-sotalol (6.1 +/- 3.3 J vs 9.1 +/- 4.6 J; P < 0.05). The difference in patients not treated with Class III drugs was found to be insignificant. Chronic amiodarone treatment increased DFT only when the longer P2 was used. CONCLUSION: Biphasic shocks with shorter P2 should be used in patients undergoing Class III antiarrhythmic treatment.