Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons Living with Psoriatic Disease

Background

Psoriasis is an immune-mediated disease associated with excess risk for cardiovascular disease (CVD). Guidelines recognize psoriasis as a CVD risk enhancer; however, psoriasis patients often do not have CVD risk factors identified nor managed.

Objective

This study examines strategies to improve CVD prevention care from the perspective of dermatologists and patients with psoriasis.

Methods

Qualitative interviews were conducted using the Consolidated Framework for Implementation Research to examine the perspectives of physicians (N = 16) and patients with psoriatic disease (N = 16) on barriers/facilitators to CVD prevention. Interviews were transcribed and coded using an integrated approach designed to enhance reliability and validity using NVivo software.

Results

We found three major themes suggesting areas to target for the future: (1) Appropriateness: perceptions of whether CVD care should be deployed in this setting by both clinicians and patients, (2) Feasibility: whether CVD prevention care could be integrated into the current structure of specialist practice, and (3) Care Coordination: an interest by all parties to better integrate a team approach in CVD preventative care to reduce duplicative efforts, work practically in an already existing system rather than reinventing the wheel, and progress with the patients' best interests in mind.

Conclusions

These findings will inform the design of a clinical trial comparing the effectiveness of specialist clinician implementation of CVD guideline-based prevention care in patients with psoriasis. Ultimately, this study aims to increase the lifespan and health of patients living with psoriatic disease by decreasing barriers to their receiving appropriate CVD prevention care.

Association between Body Condition Score and Cancer Prognosis in Dogs with Lymphoma and Osteosarcoma

Background

In humans and rodents obesity appears to promote some cancers by increasing incidence, tumor aggressiveness, recurrence, and fatality. However, the relationship between obesity and cancer in dogs has not been thoroughly evaluated.

Hypothesis/Objectives

Whether body condition score (BCS) at the time of lymphoma (LSA) or osteosarcoma (OSA) diagnosis in dogs is predictive of survival time (ST) or progression‐free interval (PFI). We hypothesized that an overweight body state at the time of cancer diagnosis would be associated with negative outcomes.

Animals

Dogs with LSA (n = 270) and OSA (n = 54) diagnosed and treated between 2000 and 2010.

Methods

Retrospective case review. Signalment, body weight, BCS, cancer diagnosis and treatment, relevant clinicopathologic values, and survival data were collected. Dogs were grouped by BCS (underweight, ideal, and overweight) and ST and PFI were compared.

Results

Overall, 5.5% of dogs were underweight, 54.0% were ideal weight, and 40.4% were overweight at diagnosis. Underweight dogs with LSA had shorter ST (P = .017) than ideal or overweight dogs. BCS was not associated with ST for OSA (P = .474). Progression‐free interval did not differ among BCS categories for either cancer.

Conclusions and Clinical Importance

Obesity was not associated with adverse outcomes among dogs with LSA or OSA in this retrospective study; however, being underweight at the time of diagnosis of LSA was associated with shorter survival. More research is needed to elucidate the relationship between excessive body weight and cancer development and progression in dogs.

Single nucleotide polymorphisms in uracil-processing genes, intake of one-carbon nutrients and breast cancer risk

BACKGROUND/OBJECTIVES

The misincorporation of uracil into DNA leads to genomic instability. In a previous study, some of us identified four common single nucleotide polymorphisms (SNPs) in uracil-processing genes (rs2029166 and rs7296239 in SMUG1, rs34259 in UNG and rs4775748 in DUT) that were associated with significantly altered levels of uracil in human DNA. We investigated whether any of these SNPs are associated with an altered risk of developing breast cancer and if one-carbon nutrients intake can modify their effects.

SUBJECTS/METHODS

We genotyped the four SNPs in 1077 cases of incident breast cancer and 1910 age and race-matched controls in the Western New York Exposures and Breast Cancer (WEB) Study and examined associations with breast cancer risk and interactions with intake of folate, vitamins B6 and B12.

RESULTS

After adjustment for known risk factors for breast cancer, there was increased risk of breast cancer among postmenopausal women who were heterozygous for either of the two SMUG1 SNPs (odds ratio (OR) 1.29, 95% confidence interval (CI) 1.07-1.56) and OR 1.29, 95% CI 1.07-1.55, respectively). Among premenopausal women, increased risk associated with the SMUG1 rs2029166 genotype was limited to those with low folate intake. There were no other interactions with vitamins B(6) or B(12) intake.

CONCLUSIONS

Our study suggests that the four selected SNPs are not robust determinants of breast cancer risk, but that the two SNPs in SMUG1 might modestly alter the risk of breast cancer. However, the increase in risk among heterozygotes in the two SNPs in SMUG1, which is thought to be the most active glycosylase in vivo, raises the possibility that subtle 'heterosis' effects on cancer risk might be produced by these SNPs.

Analysis of the outcome in male and female patients using a unisex total knee replacement system

Gender-specific total knee replacement has generated much interest recently. We reviewed 1970 Sigma knees implanted in 920 women and 592 men with a mean age of 69.7 years. At a mean follow-up of 7.3 years (minimum, five years), we found minimal differences in the outcome between genders. At the final follow-up, men had a higher overall Knee Society score and more osteolysis (3.8% vs 1.1%). However, there were no significant differences between men and women in terms of complications or improvements in knee function, pain score or range of movement. The estimated ten-year survivorship was 97% in women and 98% in men (p = 0.96). We concluded that there was little difference in outcome between the genders treated by a modern unisex design of total knee replacement in this large multicentre study.

Midterm survival of a contemporary modular total knee replacement

This retrospective study evaluated the midterm clinical and radiographic outcomes of a second-generation total knee replacement system. In a multicentre consecutive series of 1512 patients, 1970 knees were treated with the PFC Sigma knee system (Depuy, Warsaw, Indiana). The patients were reviewed for functional outcome, and underwent independent radiographic evaluation at a mean follow-up of 7.3 years (5 to 10). A total of 40 knees (2%) required revision, 17 (0.9%) for infection. The incidence of osteolysis was 2.2%. The ten-year survival with revision for any cause other than infection as the endpoint was 97.2% (95% CI 95.4 to 99.1).

The PFC Sigma knee system appears to provide excellent results in the medium term.

23 NEONATAL PHYSIOLOGICAL STATUS OF CLONED AND CONTROL CALVES

Health problems and mortality rates of cloned calves are major limitations of cloning technology and represent substantial economic losses as well as justifiable animal health and welfare concerns. The objectives of this study were to compare neonatal viability and physiological status of cloned and control calves. Cloned (Holstein, n = 5; Hereford, n = 3) and control (embryo transfer: Holstein, n = 3; Hereford, n = 3) calves were carried in the same group of Hereford × Angus crossbred recipient dams and were delivered by Cesarean section at term (Days 273–280) following induced labor. Additional calves (Holstein, n = 3; Hereford, n = 2) resulting from AI and delivered vaginally by their natural dams (Days 269–279) following spontaneous initiation of parturition were included as normal controls to evaluate the effects of the induction procedure. Physical evaluations and measurements of blood biochemistry (19 parameters), gases and electrolytes (9 parameters), and complete blood counts (18 parameters) were performed within 10 min of birth and at 1, 6, 12, 18, 24, 36, and 48 h after birth. Cloned calves were observed with increased occurrence of flexural limb deformities (4/8 clones, 0/9 controls; P < 0.05) and developmental delays of physical adjustment parameters such as time to suckle and stand (5/8 clones requiring >3 h; P < 0.05). Cloned calves were more variable than, but not different from, controls for most blood parameters measured. Compared with controls, at birth clones exhibited reduced red blood cell counts (6.8 and 8.6 × 109 cells/mL, clones and controls, respectively; P < 0.01), plasma bicarbonate (23.1 vs. 26.2 mmol/L; P < 0.05), and plasma glucose (39.4 vs. 73.6 mg/dL; P < 0.05). Blood urea nitrogen concentrations in clones tended to be elevated beginning 24 h after birth and were significantly greater than those in controls by 48 h (13.4 vs. 7.4 mg/dL; P < 0.01). Echocardiographic measurements at 24 h of age varied between groups (Table 1) and were indicative of circulatory abnormalities likely originating in utero for clones. The results of this study identified the physiological differences between clones and controls at birth and may be useful in the development of clinical-care protocols to maximize the health and survival of cloned calves. Table 1. Echocardiographic characteristics of cloned and control calves

The National Vitamin A Supplementation Program and Subclinical Vitamin A Deficiency among Preschool Children in the Philippines

The prevalence of vitamin A deficiency (serum retinol [SR] < 20 μg/dl) in children from one to five years of age in the Philippines rose from 35.8% to 38% between 1993 and 1998, despite a twice-yearly universal vitamin A capsule distribution program. The Philippines 1998 National Nutrition Survey, with one-time SR measurements from 11,620 children from one to four years of age, collected over an eight-month period from one month to more than six months after distribution of vitamin A capsules, was an opportunity to examine the impact of the program on the children's vitamin A status, using post hoc analysis. Overall, a detectable impact of vitamin A capsules on SR was limited to groups with the highest prevalence of vitamin A deficiency and lasted up to four months after dose administration. In highly urban cities in Visayas, where very high prevalences of deficient SR (SR < 10 μg/dl) were found, the prevalence of deficient SR was reduced from 27% to 9% one to two months after distribution of vitamin A capsules, and to 16% at three to four months. In Mindanao, a statistically significant reduction from 38% to 32% was seen in the prevalence of deficient to low SR (SR < 20 μg/dl) one to four months after distribution of vitamin A capsules. There was no overall reduction in the prevalence of vitamin A deficiency or deficient and low SR (SR < 20 μg/dl) in Luzon, but a significant interaction with stunting was observed in Luzon non-highly urbanized cities. Two aspects are of concern. First, the magnitude of the effect of high-dose vitamin A capsules on SR, and hence on the extent of reduction in deficiency, is limited. Second, the effect does not persist for six months, which is the interval between doses. Thus there is no decrease in the prevalence of deficiency over time. With more frequent dosing (especially to those most deficient in SR), a progressive reduction in vitamin A deficiency could, however, be expected; this hypothesis could be tested. The policy implication arising from these results is that a shift in resources is warranted. In areas of low prevalence of vitamin A deficiency, distribution of vitamin A capsules should be targeted to stunted children. In areas of high prevalence, vitamin A capsules should be distributed to children one to five years old at least three times a year.

Evidence of increased substrate availability to in vitro-derived bovine foetuses and association with accelerated conceptus growth

Changes in placental development have been associated with foetal abnormalities afterin vitroembryo manipulations. This study was designed to investigate bovine conceptus development and substrate levels in plasma and fluids inin vivo- andin vitro-produced (IVP) concepti and neonates.In vivo-produced and IVP embryos were derived by established embryo production procedures. Pregnant animals from both groups were slaughtered on days 90 or 180 of gestation, or allowed to go to term. Conceptus and neonatal physical traits were recorded; foetal, maternal and neonatal blood, and foetal fluids were collected for the determination of blood and fluid chemistry, and glucose, fructose and lactate concentrations. Placental transcripts for specific glucose transporters were determined by quantitative RT-PCR. No significant differences in uterine and conceptus traits were observed between groups on day 90. On day 180, larger uterine, placental and foetal weights, and an increase in placental gross surface area (SA) in IVP pregnancies were associated with increased glucose and fructose accumulation in foetal plasma and associated fluids, with no differences in the expression of components of the glucose transporter system. Therefore, the enlarged placental SA in IVP pregnancies suggests an increase in substrate uptake and transport capacity. Newborn IVP calves displayed higher birth weights and plasma fructose concentrations soon after birth, findings which appeared to be associated with clinical and metabolic distress. Our results indicated larger concepti and increased placental fructogenic capacity in mid- to late IVP pregnancies, features which appeared to be associated with an enhanced substrate supply, potentially glucose, to the conceptus.

Activation of methionine synthase by insulin-like growth factor-1 and dopamine: a target for neurodevelopmental toxins and thimerosal

Methylation events play a critical role in the ability of growth factors to promote normal development. Neurodevelopmental toxins, such as ethanol and heavy metals, interrupt growth factor signaling, raising the possibility that they might exert adverse effects on methylation. We found that insulin-like growth factor-1 (IGF-1)- and dopamine-stimulated methionine synthase (MS) activity and folate-dependent methylation of phospholipids in SH-SY5Y human neuroblastoma cells, via a PI3-kinase- and MAP-kinase-dependent mechanism. The stimulation of this pathway increased DNA methylation, while its inhibition increased methylation-sensitive gene expression. Ethanol potently interfered with IGF-1 activation of MS and blocked its effect on DNA methylation, whereas it did not inhibit the effects of dopamine. Metal ions potently affected IGF-1 and dopamine-stimulated MS activity, as well as folate-dependent phospholipid methylation: Cu(2+) promoted enzyme activity and methylation, while Cu(+), Pb(2+), Hg(2+) and Al(3+) were inhibitory. The ethylmercury-containing preservative thimerosal inhibited both IGF-1- and dopamine-stimulated methylation with an IC(50) of 1 nM and eliminated MS activity. Our findings outline a novel growth factor signaling pathway that regulates MS activity and thereby modulates methylation reactions, including DNA methylation. The potent inhibition of this pathway by ethanol, lead, mercury, aluminum and thimerosal suggests that it may be an important target of neurodevelopmental toxins.

Iodine fortification is related to increased weight-for-age and birthweight in children in Asia

Severe iodine deficiency causes stunting and mental retardation in utero, but the relation between mild deficiency and child growth is not well known. The use of iodated salt in relation to anthropometric data was examined from recent survey data. After potential confounding factors had been controlled for, significant associations were seen in Bangladesh, India, Nepal, and Sri Lanka. The use of iodated salt was related to increased weight-for-age and mid-upper-arm circumference, most strongly in the second year of life, mainly affecting soft tissue (thinness). The relation with weight-for-age was greater among children of mothers with lower body mass index. The use of iodated salt was related to birthweight in Sri Lanka and in the Philippines, where iodized oil capsules given during pregnancy had a negative effect when used with high levels of iodine in salt. The associations generally were concentrated in large geographic areas, possibly because of interactions with other environmental factors (e.g., selenium and arsenic). The apparent growth response to iodine may reflect functional effects of mild deficiency, which is widespread, possibly including effects on brain development.