Gender and ethnic differences in red cell distribution width and its association with mortality among low risk healthy United state adults

Limited information is available about gender and ethnic differences in red cell distribution width (RCDW) with regard to its relation to mortality in a population free of cardiovascular (CV) disease and diabetes. To assess gender and ethnic differences in RCDW and their effect on the association between RCDW and mortality, the Third National Health and Nutritional Examination Survey (n = 15,460, 1988 to 1994) data were examined. Multivariate adjusted Cox proportional hazard analysis was performed to assess effect of gender and ethnicity on the association between RCDW and mortality (total, CV disease, and coronary heart disease [CHD]). RCDW (mean ± SE) was greater in black women (13.1 ± 0.03) and men (13.4 ± 0.02) compared to women of white (12.9 ± 0.02) and other (13.0 ± 0.07) ethnicities and men of white (13.3 ± 0.02) and other (13.3 ± 0.07) ethnicities, respectively (p <0.001). The interaction between RCDW and gender was statistically significant for all study outcomes (p <0.001) but nonsignificant for RCDW and ethnicity. After adjusting for key variables, RCDW in women was associated with adjusted hazard ratios of 1.22 (95% confidence interval [CI] 1.14 to 1.31) for all-cause mortality, 1.17 (95% CI 1.07 to 1.28) for CV deaths, and 1.18 (95% CI 1.03 to 1.35) for CHD deaths; in men, adjusted hazard ratios were 1.29 (95% CI 1.20 to 1.38) for all-cause mortality, 1.27 (95% CI 1.17 to 1.37) for CV deaths, and 1.25 (95% CI 1.13 to 1.39) for CHD deaths (p <0.05 for all). In conclusion, blacks and men have significantly greater RCDWs compared to whites and women. Greater RCDW is associated with a greater risk of mortality in men compared to women, whereas no effect modification is observed by ethnicity.     

The Association of Red Cell Distribution Width with Glycated Hemoglobin among Healthy Adults without Diabetes Mellitus

Background: Red cell distribution width (RDW) and hemoglobin A1c (HbA1c) are both known to be predictive of future cardiovascular disease (CVD). Objective: We hypothesized that RDW would be associated with HbA1c in adults without diabetes independent of fasting blood glucose (FBG). Methods: This cross-sectional study included 15,343 nondiabetic adults, free of CVD, enrolled in NHANES 1999-2008. Adjusted means of RDW were calculated across HbA1c categories for the overall population. Multivariable regression analyses were performed analyzing the association between RDW and HbA1c for individuals with available data on FBG (n = 7,454). Results: RDW significantly correlated with HbA1c (r = 0.27, p < 0.001; n = 15,343), with a gradual increase in adjusted mean RDW across HbA1c categories (12.59% ± 0.02% in the group with HbA1c ≤4.8% vs. 12.92% ± 0.02% in the group with HbA1c >5.8%, p < 0.001 for trend). In regression analyses, RDW independently predicted HbA1c (β-coefficient 0.034, 95% CI 0.026-0.042, p < 0.001). Conclusion: RDW significantly predicts HbA1c independent of FBG in healthy nondiabetic adults, suggesting the possibility of chronic hyperglycemia mediating the association between RDW and CVD.     

Effects of anxiety on TNF-alpha levels during psychological stress

OBJECTIVES: Psychological stress can influence the immune system, which may result in stress-related illnesses. In this study, we investigated the effect of psychological stress and the coping skill on plasma cytokine levels. MATERIALS AND METHODS: One hundred eighty-three students, at different stages of an academic year, participated in this study. Plasma tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-2 soluble receptor alpha, and IL-4 were measured and examined in relation to the measures of anxiety [State Anxiety Inventory (SAI)] and Bell Adjustment Inventory (BAI) score. RESULTS: SAI scores were significantly higher in both midterm students (MTS) and examination-taking students (ETS), compared with the freshly admitted students (FAS). In addition, TNF-alpha levels were significantly different between the high- and the low-anxiety groups of ETS but not in MTS or FAS. The correlation between SAI scores and the BAI emotional scores was highest in the ETS group. CONCLUSIONS: TNF-alpha level was significantly lower in the ETS group with high anxiety scores, and it is situation specific.     

Targeted disruption of the cyclin-dependent kinase 5 gene results in abnormal corticogenesis, neuronal pathology and perinatal death.

Although cyclin-dependent kinase 5 (Cdk5) is closely related to other cyclin-dependent kinases, its kinase activity is detected only in the postmitotic neurons. Cdk5 expression and kinase activity are correlated with the extent of differentiation of neuronal cells in developing brain. Cdk5 purified from nervous tissue phosphorylates neuronal cytoskeletal proteins including neurofilament proteins and microtubule-associated protein tau in vitro. These findings indicate that Cdk5 may have unique functions in neuronal cells, especially in the regulation of phosphorylation of cytoskeletal molecules. We report here generation of Cdk5(-/-) mice through gene targeting and their phenotypic analysis. Cdk5(-/-) mice exhibit unique lesions in the central nervous system associated with perinatal mortality. The brains of Cdk5(-/-) mice lack cortical laminar structure and cerebellar foliation. In addition, the large neurons in the brain stem and in the spinal cord show chromatolytic changes with accumulation of neurofilament immunoreactivity. These findings indicate that Cdk5 is an important molecule for brain development and neuronal differentiation and also suggest that Cdk5 may play critical roles in neuronal cytoskeleton structure and organization.     

Terrorism and the heart: implications for arrhythmogenesis and coronary artery disease

The destruction of the World Trade Center and associated terrorist activities of September 11, 2001 have spurred interest in understanding the medical consequences of terrorist activity. Currently, there is a paucity of data regarding this subject. Potential effects, however, can be garnered by studying the medical effects of other acute stressors, such as earthquakes, missile attacks, and the like. None of these stressors have been studied extensively, but there is enough data available concerning earthquakes to indicate that in some instances, the effects of the earthquake may last at least a period of weeks, if not months, following the earthquake. Since the World Trade Center attack was associated with a rise in post-traumatic stress syndrome and affective disorders afterwards, there is accordingly interest in both the acute and more prolonged health effects that could be engendered following terrorist attacks.Known pathophysiological effects of acute stress, whether produced in a laboratory environment or by studying naturally occurring acute stressors, include: the induction or potentiation of cardiac arrhythmias; the induction of myocardial ischemia in susceptible patients with underlying coronary artery disease; acute increases in arterial blood pressure with its ability to cause shear stress; the precipitation of worsening endothelial function and/or endothelial injury; coagulation abnormalities; and hemoconcentration. These all represent important areas for study following the occurrence of future terrorist activity.Based on existing epidemiological and pathophysiological data concerning the cardiac effects of acute life stressors, it would behoove physicians to closely monitor high-risk cardiac patients following future terrorist events. In addition, physician-scientists should be well prepared to use new epidemiological markers which could provide rapid information following future events, such as the evaluation of patients using pre-versus post-event serum markers or tracing records available among patients fitted with implantable cardiovertor-defibrillators.     

Predictors of poor outcome in children with steroid sensitive nephrotic syndrome

Background and objective

Nearly 50% of the children with steroid sensitive nephrotic syndrome (SSNS) have a frequently relapsing (FR) or steroid dependent (SD) course, experiencing steroid toxicities and complications of immunosuppression. The study aimed to compare parameters between children with infrequent relapsing (IFR) and FR/SD nephrotic syndrome and to identify the factors associated with a FR/SD course.

Preserved or slightly depressed ejection fraction and outcomes after myocardial infarction

BACKGROUND Left ventricular ejection fraction (EF) in post-myocardial infarction (MI) patients is a strong predictor of adverse cardiovascular events. Although resting EF as measured by transthoracic echocardiography (TTE), contrast ventriculography (CNV), and radionuclide angiography (RNA) exhibit high correlation, there is only modest agreement between these modalities. This study sought to explore whether modality of EF assessment influences prognostication of post-MI patients with normal or slightly reduced EF. METHODS AND RESULTS The National Heart, Lung, and Blood Institute (NHLBI) limited access dataset of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial (1996-2003, n=8290) comparing trandolapril versus placebo was used. The cohort was partitioned into TTE (n=2582), RNA (n=816), and CNV (n=1155) groups based on modality of EF assessment. EF was a significant predictor of cardiovascular mortality (HR 0.97, 95% CI 0.95 to 0.98; p<0.005) and all cause mortality (HR 0.98, 95% CI 0.97 to 0.99; p=0.0002) on multivariate analysis in this population with preserved or mildly depressed EF. Although CNV, TTE, and RNA groups differed significantly in terms of baseline variables, no appreciable differences were noted between RNA (HR 1.13, 95% CI 0.85 to 1.50; ns) and CNV (HR 1.13, 95% CI 0.99 to 1.27; ns) groups, compared with TTE for all cause mortality. Similarly, no significant differences were observed for cardiovascular mortality between RNA (HR 1.23, 95% CI 0.82 to 1.84; p=0.31) and CNV (HR 1.14, 95% CI 0.78 to 1.67, p=0.49) versus TTE. CONCLUSION EF is a significant predictor of all-cause mortality and cardiovascular mortality in patients with preserved or mildly depressed EF. Modalities of EF measurement are interchangeable and do not play a significant role in prognostication in a post-MI population.     

Unilateral nevoid hyperkeratosis of the nipple: a report of two cases

Nevoid hyperkeratosis of the nipple and areola is an unusual condition. Two female patients aged 31 and 18 years presented with chronic unilateral warty lesions of the nipple. One patient had difficulty in breastfeeding from the affected side. A skin biopsy showed acanthosis, hyperkeratosis, papillomatosis and lymphocytic infiltrate in the dermis. There was no significant improvement with topical tretinoin cream in both the patients.