Retinol-binding protein 4 is associated with components of the metabolic syndrome, but not with insulin resistance, in men with type 2 diabetes or coronary artery disease

AIMS/HYPOTHESIS

Retinol-binding protein 4 (RBP4) has recently been reported to be associated with insulin resistance and the metabolic syndrome. This study tested the hypothesis that RBP4 is a marker of insulin resistance and the metabolic syndrome in patients with type 2 diabetes or coronary artery disease (CAD) or in non-diabetic control subjects without CAD.

METHODS

Serum RBP4 was measured in 365 men (126 with type 2 diabetes, 143 with CAD and 96 control subjects) and correlated with the homeostasis model assessment of insulin resistance index (HOMA-IR), components of the metabolic syndrome and lipoprotein metabolism. RBP4 was detected by ELISA and validated by quantitative Western blotting.

RESULTS

RBP4 concentrations detected by ELISA were shown to be strongly associated with the results gained in quantitative Western blots. There were no associations of RBP4 with HOMA-IR or HbA(1c) in any of the groups studied. In patients with type 2 diabetes there were significant positive correlations of RBP4 with total cholesterol, LDL-cholesterol, VLDL-cholesterol, plasma triacylglycerol and hepatic lipase activity. In patients with CAD, there were significant associations of RBP4 with VLDL-cholesterol, plasma triacylglycerol and hepatic lipase activity, while non-diabetic control subjects without CAD showed positive correlations of RBP4 with VLDL-cholesterol and plasma triacylglycerol.

CONCLUSIONS/INTERPRETATION

RBP4 does not seem to be a valuable marker for identification of the metabolic syndrome or insulin resistance in male patients with type 2 diabetes or CAD. Independent associations of RBP4 with pro-atherogenic lipoproteins and enzymes of lipoprotein metabolism indicate a possible role of RBP4 in lipid metabolism.

Evaluation of the expectations osteoarthritis patients have concerning healthcare, and their implications for practitioners

BACKGROUND

The expectations of patients with osteoarthritis are essential for health care provision and may be used to improve the patient-doctor relationship.

METHODS

A total of 96 osteoarthritis patients aged 42-89 years (mean=65; 81% female) were recruited among customers of 10 pharmacies in 10 towns in 10 regions (selected at random from the 22 French regions). Ten focus groups were organized looking at three categories of expectation: 1) Information about and understanding of osteoarthritis; its impact on lifestyle, and its treatment, consequences, and outlook; 2) Communication skills, attitudes of practitioners and communication between health professionals; 3) Support available from doctors, family circle and society.

RESULTS

The patient-practitioner relationship begins with a dialogue, the quality of which, the participants could be improved by: developing greater trust: patients expect communication skills and expressions of sympathy that practitioners seem ill-prepared to provide. Strengthening involvement: general practitioners in particular should act as mediators and facilitators to improve recognition and understanding of osteoarthritis by employers and public decision-makers.

CONCLUSION

The present study enabled patients to express their expectations. Meeting those expectations could markedly improve the therapeutic process, but the question arises of whether practitioners are ready to agree that there is a need to reconsider and modify the care they provide for their patients.

2-Isopropylthioxanthone (2-ITX) in food and food packaging materials on the German market

To elucidate the occurrence of the photo-initiator, 2-isopropylthioxanthone (2-ITX), more than 100 food products on the German market, packed in cartons, plastic cups and foils, were investigated. For this, a rapid method to detect 2-ITX in food packaging materials was established. In case of positive findings, the accompanying foodstuffs were analysed in a subsequent step using different extraction methods, depending on the fat content of the food. Determination of the photo-initiator was done by high-performance liquid chromatography with diode array and fluorescence detection (HPLC-DAD/FLD). Recoveries ranged between 94 and 106% for non-fatty (RSD <or= 1.1) and between 80 and 105% for fatty foods (RSD <or= 8.5). The limit of detection and limit of quantification were determined to 2 and 5 microg l(-1). 2-ITX was detected in 36 of 137 packages (26%) and significant migration occurred in 75% of the packaging materials tested positive. The levels of 2-ITX ranged up to 357 microg kg(-1) in orange juice.

High dose pulsatile dexamethasone therapy in children with opsoclonus-myoclonus syndrome

Opsoclonus-myoclonus syndrome (OMS) is a rare movement disorder characterized by chaotic eye movements, myoclonus, and ataxia associated with severe irritability. Different treatment modalities including steroids and cyclophosphamide have been tried in the past often with significant side effects and variable success. Here we present 11 children, diagnosed with OMS between 1999 and 2005 and treated with high dose dexamethasone pulses. Main symptoms at presentation were opsoclonus (11/11), ataxia and/or myoclonus (11/11), irritability (10/11) associated with a neuroblastoma in four children. Number of dexamethasone pulses ranged from 6 to 60 pulses. No major side effects were reported. In 6/11 children a complete and sustained remission of OMS symptoms was achieved after 6 to 29 pulses of dexamethasone. Two children from this group have a normal development and no neurological sequelae. Two further children have minor delays in fine- and gross-motor skills. Two children despite a complete recovery of OMS symptoms have persisting developmental problems. 5/11 children still require regular dexamethasone pulses in addition to daily prednisolone (n = 1) or have received cyclophosphamide pulses meanwhile (n = 2). All children continue to have developmental and neurological difficulties. In summary treatment with high dose pulsatile dexamethasone appears to be safe and beneficial in a subgroup of patients with OMS.

[First results with catheter and magnetically guided and detached polymerized ferromagnetic particle filaments and heat-induced particle release using the Stereotaxis Niobe system]

PURPOSE

To develop a new technique for intravascular guidance and the release of magnetized ferromagnetic nanoparticles using a polymerized filament by means of an external magnetic field.

MATERIALS AND METHODS

Ferromagnetic nanoscaled beads were embedded in temperature-sensitive gels to form filaments after polymerization. Deflection of the filaments was assessed in a Stereotaxis Niobe magnetic navigation system (MNS) in comparison with dedicated guide wires. The curvature was measured as a surrogate parameter for deflection. In combination with commercially available catheters, the filaments were navigated in a perfused aneurysmatic vessel model and a perfused branched vessel model under the influence of two permanent magnets of the Niobe MNS. The magnetic field vector was varied in all three dimensions. After positioning, the magnetic colloid-containing filaments were exposed to an electromagnetic field of 45 kA/m, 200 kHz for a period of 5 minutes for non-invasive heating.

RESULTS

The filaments showed superior deflectability compared to the dedicated guide wires (p = 0.0091). The curvature was 0.54 +/- 0.12 mm(-1) for the filaments and 0.33 +/- 0.21 mm(-1) for the guide wires. In combination with angiography catheters, magnetic guidance and accumulation of specially designed filaments were possible in the perfused vessel model. Inductive heating allowed non-invasive disintegration and releasing of the nanoparticles in all filaments.

CONCLUSION

This feasibility study shows that magnetic guidance and targeting of a specially designed magnetic colloid-containing filament and subsequent disintegration are feasible. This technique offers the potential for controlled local drug release.

Postoperative concurrent radiochemotherapy versus radiotherapy in high-risk SCCA of the head and neck: Results of the German phase III trial ARO 96–3

5507

Background: Despite resection and postoperative irradiation high-risk (3 or more involved lymph nodes, extra-capsular disease and/or microscopically involved mucosal margins of resection) squamous cell carcinomas (SCCAs) of the head and neck frequently recur in the tumor bed. Postoperatively radiochemotherapy (RCT) with cis-Platin (CDDP)/5-FU versus radiotherapy (RT) alone was compared in a randomized trial. Methods: Between 5/97 and 12/04, 440 patients who had high-risk SCCAs of the head and neck were enrolled in this prospectively randomized phase III trial. Following resection and neck dissection, 214 patients were randomly assigned to RT (66 Gy/33 Fx/6.6 weeks) and 226 patients to identical RT plus CDDP (20 mg/m2 on day 1–5, 29–33) and 5-FU (600 mg/m2 on day 1–5, 29–33). Results: The 5 year local-regional control rate is 72.2 ± 3.7% following RT and 88.6 ± 2.4% for the RCT group (p = 0.00259; 5-year progression free survival 50.1 ± 4.0% and 62.4 ± 4.4% (p = 0.024) and 5-year overall survival 48.6 ± 4.4% vs. 58.1 ± 4.6% (p = 0.11). There was no difference in the 5 year incidence of distant metastases (19.3 ± 3.6% vs 25.5 ± 4.6%; p = 0.45). The incidence of grade 3+ acute toxicity was higher during RCT: mucositis 12.6% vs. 20.8% (p = 0.04), leucopenia 0% vs. 4.4% (p = 0.007). Conclusions: Acute toxicity is increased to an acceptable level by RCT. Postoperative RCT compared to RT improves locoregional control and progression free survival; thus survival as a trend is improved by 10% after 5 years. Supported by Deutsche Krebshilfe 70–2140.

No significant financial relationships to disclose.

Development of invasive disease in 433 women treated for vulvar, vaginal or perianal intraepithelial neoplasia

5043

Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients.

No significant financial relationships to disclose.

[Bavarian mammography screening program]

In Bavaria since the 1st April 2003 we have been conducting a high quality mammography-screening carried out in individual practises (BMS). We have used the European and the S 3 guidelines. The best diagnosis is an early diagnosis of the breast carcinoma to save human life. Because of this and the high mortality rate due to this disease it is essential to have a mammogram screening program. There is no single one ideal way of constructing a screening program, it is always based on compromise within the particular health care-systems. Arising problems cannot be avoided, it is only possible when all parties work closely together that the BMS works properly.

Different classes of EGFR inhibitors may have different potential to improve local tumour control after fractionated irradiation: a study on C225 in FaDu hSCC

BACKGROUND AND PURPOSE

Previous experiments reported from this laboratory have shown that simultaneous application of the selective epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitor BIBX1382BS during fractionated irradiation significantly prolonged growth delay of FaDu human squamous cell carcinoma but did not improve local tumour control. The present study investigates the effect of the EGFR monoclonal antibody (mAb) C225 on local tumour control of FaDu tumours after combined treatment with single dose and fractionated irradiation to address whether different classes of EGFR inhibitors have different potential to improve the outcome of radiotherapy in the same tumour model.

MATERIAL AND METHODS

In unirradiated tumours, C225 was given either once or 4 times i.p. to the nude mice. Irradiation experiments were performed with graded single doses under clamp hypoxic conditions or with 30 fractions in 6 weeks with graded total doses under ambient blood flow. C225 was given 6h before or 6 h before and 2, 5 and 7 days after single dose irradiation. During fractionated irradiation C225 was given once per week. Experimental endpoints were tumour growth delay and local tumour control 120 after end of irradiation.

RESULTS

C225 treatment resulted in prolongation of tumour growth delay after drug treatment alone as well as after single dose and fractionated irradiation. TCD50 values were reduced from 56.3 Gy [95% CI 50; 62 Gy] after single dose irradiation alone to 46.0 Gy [41;51] (enhancement ratio [ER]=1.22, P<0.01) after 1 C225 injection and 47.7 Gy [44; 51] after 4 injections of the drug (ER=1.18, P=0.06). After fractionated irradiation, tumour control dose 50% (TCD50) was 73.0 Gy [64; 82] in control tumours and 63.1 Gy [57; 69] after simultaneous C225 treatment, corresponding to an ER of 1.2 (P=0.01).

CONCLUSION

Treatment of FaDu hSCC with the anti-EGFR mAb C225 resulted in a significant prolongation of tumour growth delay after single dose and fractionated irradiation. In contrast to previous results on the EGFR-TK inhibitor BIBX1382BS, this prolongation of growth delay translated into a slight but significant improvement of local tumour control. The data indicate that different classes of EGFR inhibitors may have different potential to improve the outcome of radiotherapy in the same tumour model.

Quality of life and attitudes towards psychotropics and dependency: consumers vs. non-consumers aged 50 and over

AIM

To assess the relationships between socio-demographic factors, quality of life and attitudes towards psychotropic drugs and dependency and to compare those relationships in continuous consumers (CC), occasional consumers (OC) and non-consumers (NC) of those drugs.

METHODS

Quality of life (SF36) and attitudes (14 statements) were measured in 601 subjects (45-60 years old) from the SUVIMAX cohort (SUpplementation en VItamines et en sels Mineraux AntioXydants). Data were obtained on 334 NC, 142 CC, 125 OC from the inclusion questionnaire and the monthly consumption report notebooks kept by subjects between 1994 and 1998. Dichotomous and polychotomous logistic regressions were used for the analysis.

RESULTS

The lower the quality of life score the more frequent was consumption. NC tended to be men, with high quality of life scores. They entertained negative attitudes towards psychotropics and dependency. OC tended to be women reporting a chronic pathology, with fairly high social status. They had intermediate quality of life and denied dependency. CC tended to be men with no professional activity and low quality of life scores in particular for mental health and perceived health. They had positive attitudes towards psychotropics and accept dependency.

DISCUSSION

Assessment of patients' quality of life and understanding of their attitudes towards psychotropics can provide essential information for those in charge of health promotion programmes and may help in identifying new intervention strategies. Preventive education and follow-up of therapy may be better suited to the needs of patients.

Palpation imaging using a haptic system for virtual reality applications in medicine

In the field of medical diagnosis, there is a strong need to determine mechanical properties of biological tissue, which are of histological and pathological relevance. Malignant tumors are significantly stiffer than surrounding healthy tissue. One of the established diagnosis procedures is the palpation of body organs and tissue. Palpation is used to measure swelling, detect bone fracture, find and measure pulse, or to locate changes in the pathological state of tissue and organs. Current medical practice routinely uses sophisticated diagnostic tests through magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) imaging. However, they cannot provide direct measure of tissue elasticity. Last year we presented the concept of the first haptic sensor actuator system to visualize and reconstruct mechanical properties of tissue using ultrasonic elastography and a haptic display with electrorheological fluids. We developed a real time strain imaging system for tumor diagnosis. It allows biopsies simultaneously to conventional ultrasound B-Mode and strain imaging investigations. We deduce the relative mechanical properties by using finite element simulations and numerical solution models solving the inverse problem. Various modifications on the haptic sensor actuator system have been investigated. This haptic system has the potential of inducing real time substantial forces, using a compact lightweight mechanism which can be applied to numerous areas including intraoperative navigation, telemedicine, teaching and telecommunication.