Pain in femoral arteriography: A double-blind, randomized, clinical study comparing safety and efficacy of the iso-osmolar iodixanol 270mgI/ml and the low-osmolar iomeprol 300 mgI/ml in 9 European centers

Purpose: To compare the injection-associated pain and heat sensation after administration of the iso-osmolar contrast medium (IOCM) iodixanol (Visipaque™ 270 mg I/ml) and the low osmolar contrast medium (LOCM) iomeprol (Iomeron™ 300 mg I/ml) in femoral arteriography.

Material and Methods: 352 patients received iodixanol or iomeprol in a prospective, double-blind, randomized, parallel-group clinical trial. The first injection during femoral arteriography (DSA with automated stepping) was standardized. Injection-associated pain and heat sensation, efficacy and safety up to 72 h were evaluated.

Results: The iodixanol group reported significant less injection-associated pain than the iomeprol group after the first injection (7.4% vs. 17.6%; p = 0.007), and after all injections (11% vs. 19.4%; p = 0.045). Iodixanol caused less heat sensation after the first injection ( p = 0.007) and after all injections ( p = 0.029). Heat sensations in the iodixanol group were less intense after all injections ( p < 0.0001). No difference was found between the groups regarding the frequency of patients having adverse reactions (5.1% vs. 4%).

Conclusion: The IOCM iodixanol caused significantly less frequent injection-associated pain and heat sensation than the LOCM iomeprol during femoral arteriography.

Spatiotemporal variation and social determinants of suicide in China, 2006-2012: findings from a nationally representative mortality surveillance system

BACKGROUND

Suicide in China has declined since the 1990s. However, there has been limited investigation of the potential spatiotemporal variation and social determinants of suicide during subsequent periods.

METHOD

Annual suicide counts from 2006 to 2012 stratified by county, 5-year age group (⩾15 years) and gender were obtained from the Chinese Disease Surveillance Points system. Trends and geographic differentials were examined using multilevel negative binomial regression models to explore spatiotemporal variation in suicide, and the role of key sociodemographic factors associated with suicide.

RESULTS

The suicide rate (per 100 000) in China decreased from 14.7 to 9.1, 2006-2012. Rates of suicide were higher in males than females and increased substantially with age. Suicide rates were higher in rural areas compared with urban areas; however, urban-rural disparities reduced over time with a faster decline for rural areas. Within both urban and rural areas, higher rates of suicide were evident in areas with lower socio-economic circumstances (SEC) [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.31-2.62]. Suicide rates varied more than twofold (median RR 2.06) across counties, and were highest in central and southwest regions of China. A high proportion of the divorced population, especially for younger females, was associated with lower suicide rates (RR 0.60, 95% CI 0.46-0.79).

CONCLUSIONS

Geographic variations for suicide should be taken into account in policy making, particularly for older males living in rural areas and urban areas with low SEC. Measures to reduce disparities in socio-economic level and alleviate family relation stress are current priorities.

Human behavior. Sex equality can explain the unique social structure of hunter-gatherer bands

The social organization of mobile hunter-gatherers has several derived features, including low within-camp relatedness and fluid meta-groups. Although these features have been proposed to have provided the selective context for the evolution of human hypercooperation and cumulative culture, how such a distinctive social system may have emerged remains unclear. We present an agent-based model suggesting that, even if all individuals in a community seek to live with as many kin as possible, within-camp relatedness is reduced if men and women have equal influence in selecting camp members. Our model closely approximates observed patterns of co-residence among Agta and Mbendjele BaYaka hunter-gatherers. Our results suggest that pair-bonding and increased sex egalitarianism in human evolutionary history may have had a transformative effect on human social organization.

Polygyny without wealth: popularity in gift games predicts polygyny in BaYaka Pygmies

The occurrence of polygynous marriage in hunter-gatherer societies, which do not accumulate wealth, remains largely unexplored since resource availability is dependent on male hunting capacity and limited by the lack of storage. Hunter-gatherer societies offer the greatest insight in to human evolution since they represent the majority of our species' evolutionary history. In order to elucidate the evolution of hunter-gatherer polygyny, we study marriage patterns of BaYaka Pygmies. We investigate (i) rates of polygyny among BaYaka hunter-gatherers; (ii) whether polygyny confers a fitness benefit to BaYaka men; (iii) in the absence of wealth inequalities, what are the alternative explanations for polygyny among the BaYaka. To understand the latter, we explore differences in phenotypic quality (height and strength), and social capital (popularity in gift games). We find polygynous men have increased reproductive fitness; and that social capital and popularity but not phenotypic quality might have been important mechanisms by which some male hunter-gatherers sustained polygynous marriages before the onset of agriculture and wealth accumulation.

NFκB1 is a suppressor of neutrophil-driven hepatocellular carcinoma

Hepatocellular carcinoma (HCC) develops on the background of chronic hepatitis. Leukocytes found within the HCC microenvironment are implicated as regulators of tumour growth. We show that diethylnitrosamine (DEN)-induced murine HCC is attenuated by antibody-mediated depletion of hepatic neutrophils, the latter stimulating hepatocellular ROS and telomere DNA damage. We additionally report a previously unappreciated tumour suppressor function for hepatocellular nfkb1 operating via p50:p50 dimers and the co-repressor HDAC1. These anti-inflammatory proteins combine to transcriptionally repress hepatic expression of a S100A8/9, CXCL1 and CXCL2 neutrophil chemokine network. Loss of nfkb1 promotes ageing-associated chronic liver disease (CLD), characterized by steatosis, neutrophillia, fibrosis, hepatocyte telomere damage and HCC. Nfkb1^S340A/S340Amice carrying a mutation designed to selectively disrupt p50:p50:HDAC1 complexes are more susceptible to HCC; by contrast, mice lacking S100A9 express reduced neutrophil chemokines and are protected from HCC. Inhibiting neutrophil accumulation in CLD or targeting their tumour-promoting activities may offer therapeutic opportunities in HCC.

The role of neutrophils in cancer development is not widely appreciated. Here, the authors show that NF-κB-deficient hepatocytes overproduce chemokines, leading to hepatocellular carcinoma due to excessive neutrophil recruitment, and that neutrophil depletion prevents liver cancer in these mice.

Validation and evaluation of VapA-specific IgG and IgG subclass enzyme-linked immunosorbent assays (ELISAs) to identify foals with Rhodococcus equi pneumonia

REASONS FOR PERFORMING STUDY

Rhodococcus equi (Rhodococcus hoagii/Prescottella equi) is a common cause of foal pneumonia, but its diagnosis remains a challenge for equine veterinarians. While the VapA-specific (virulence-associated protein A) immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) has low sensitivity and specificity for detecting pneumonic foals, little is known about VapA-specific IgG subclasses.

OBJECTIVES

To evaluate the performance of VapA-specific ELISA for IgG and its subclasses IgGa, IgGb and IgG(T) in the early diagnosis of pneumonia caused by R. equi.

STUDY DESIGN

Assay validation followed by assessment of diagnostic performance using archived samples from animals of known status.

METHODS

Serum samples from exposed (n = 125) and nonexposed adult horses (n = 10) and from experimentally challenged and naturally infected foals were used for ELISA validation. Post mortem and tissue culture records of the last 24 years from the Institute for Experimental Pathology at the University of Iceland in Keldur, Iceland laboratory were evaluated to confirm the absence of R. equi cases in Iceland. The diagnostic performance of VapA-specific IgG and its subclasses was evaluated using banked serum samples from pneumonic (n = 21) and healthy foals (n = 80). To evaluate each IgG assay, a cut-off value was selected based on receiver operating characteristic curve analysis and used to calculate sensitivity and specificity. The intra- and interassay coefficients of variation were calculated for each ELISA.

RESULTS

Using sera from Iceland, where R. equi infection has not been reported, the VapA-specific IgG ELISA differentiated exposed from nonexposed horses. When used to identify infected foals, VapA-specific IgG, IgGa and IgGb had no diagnostic value. In contrast, IgG(T) had high sensitivity and specificity.

CONCLUSIONS

Horses from Iceland are not exposed to VapA(+) R. equi and can serve as negative controls. VapA-specific IgG subclasses, with the exception of IgG(T), are poor predictors of disease. Further investigation on the use of IgG(T) as a diagnostic tool in field conditions is needed.

Excess NF-κB induces ectopic odontogenesis in embryonic incisor epithelium

Nuclear factor kappa B (NF-κB) signaling plays critical roles in many physiological and pathological processes, including regulating organogenesis. Down-regulation of NF-κB signaling during development results in hypohidrotic ectodermal dysplasia. The roles of NF-κB signaling in tooth development, however, are not fully understood. We examined mice overexpressing IKKβ, an essential component of the NF-κB pathway, under keratin 5 promoter (K5-Ikkβ). K5-Ikkβ mice showed supernumerary incisors whose formation was accompanied by up-regulation of canonical Wnt signaling. Apoptosis that is normally observed in wild-type incisor epithelium was reduced in K5-Ikkβ mice. The supernumerary incisors in K5-Ikkβ mice were found to phenocopy extra incisors in mice with mutations of Wnt inhibitor, Wise. Excess NF-κB activity thus induces an ectopic odontogenesis program that is usually suppressed under physiological conditions.

Administration of commercial Rhodococcus equi specific hyperimmune plasma results in variable amounts of IgG against pathogenic bacteria in foals

Rhodococcus equi is the most common cause of pneumonia in young foals. A vaccine is not available and the use of R equi-specific hyperimmune plasma (HIP) is common. Despite its widespread use, the efficacy of HIP in preventing disease remains controversial. The objectives of this study were (1) to evaluate the virulence associate protein A (VapA)-specific IgG and IgG subclasses in commercially available R equi HIP and (2) to evaluate serum VapA-specific IgG and IgG subclasses in foals following administration of commercial R equi HIP. Three different lots from four commercial R equi HIP were sampled. VapA-specific IgG and IgG subclasses were evaluated in all samples using an ELISA. Serum was collected from newborn foals either after commercial R equi HIP was administered (n=97) or not (n=70). Serum was also collected from each mare. Administration of HIP significantly (P<0.001) increased VapA-specific IgGs in recipient foals, however, there was a marked variation in VapA-specific IgGs in foals receiving the same product. VapA-specific IgGs were significantly different (P<0.001) between products and varied between lots, with coefficients of variation ranging from 17 to 123 per cent. These results may explain previously reported disparities in HIP efficacy.

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

BACKGROUND

There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide.

METHOD

A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained.

RESULTS

Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33-1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00-1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females.

CONCLUSIONS

Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.

Children with nephrotic syndrome have greater bone area but similar volumetric bone mineral density to healthy controls

BACKGROUND

Glucocorticoid use has been associated with an increased fracture risk and reduced bone mineral density (BMD), particularly in the trabecular compartment. However the contribution of the underlying inflammatory disease process to these outcomes is poorly understood. Childhood nephrotic syndrome (NS) typically follows a relapsing-remitting course often requiring recurrent courses of glucocorticoids, but with low systemic inflammation during remission. NS therefore represents a useful clinical model to investigate the effects of glucocorticoids on BMD and bone geometry in childhood.

METHODS

Children with NS were compared to age and sex matched healthy controls. Body composition and areal BMD (whole body, lumbar spine and hip) were assessed by DXA. Peripheral quantitative computed tomography (pQCT) scans were obtained at metaphyseal (4%) and diaphyseal (66%) sites of the tibia to determine volumetric BMD and bone cross-sectional geometry. Lifetime cumulative glucocorticoid exposure was calculated from medical records.

RESULTS

29 children with NS (55% male, age 10.7±3.1years) were compared to 29 healthy controls (55% male, age 11.0±3.0years). The children with NS were of similar height SDS to controls (p=0.28), but were heavier (0.65±1.28SDS vs -0.04±0.89SDS, p=0.022) and had greater body fat percentage SDS (0.31±1.01 vs -0.52±1.10, p=0.008). Tibial trabecular and cortical vBMD were similar between the two groups but bone cross-sectional area (CSA) was significantly greater in children with NS at both the metaphysis (954±234mm(2) vs 817±197mm(2), p=0.002) and diaphysis (534.9±162.7mm(2) vs 463.2±155.5mm(2), p=0.014). Endosteal and periosteal circumferences were greater in children with NS than controls (both p<0.01), resulting in reduced cortical thickness (2.4±0.7mm vs 2.8±0.7mm, p=0.018), but similar cortical CSA (p=0.22). The differences in cortical geometry were not statistically significant when weight was included as a confounding factor. There were no associations between cumulative steroid exposure, duration of NS or number of relapses and any bone parameter.

CONCLUSIONS

Tibial bone CSA is increased in children with NS. We speculate that this is a compensatory response to increased body weight. Defects in trabecular BMD were not identified in this cohort of children with NS.

The effect of leaving employment on mental health: testing 'adaptation' versus 'sensitisation' in a cohort of working-age Australians

OBJECTIVES

To investigate the 'adaptation' versus 'sensitisation' hypotheses in relation to mental health and labour market transitions out of employment to determine whether mental health stabilised (adaptation) or worsened (sensitisation) as people experienced one or more periods without work.

METHODS

The Household Income and Labour Dynamics of Australia (HILDA) longitudinal survey was used to investigate the relationship between the number of times a person had been unemployed or had periods out of the labour force (ie, spells without work) and the Mental Component Summary (MCS) of the Short Form 36 (SF-36). Demographic, health and employment related confounders were included in a series of multilevel regression models.

RESULTS

During 2001-2010, 3362 people shifted into unemployment and 1105 shifted from employment to not in the labour force. Compared with participants who did not shift, there was a 1.64-point decline (95% CI -2.05 to -1.23, p<0.001) in scores of the MCS SF-36 among those who had one spell of unemployment (excluding not in the labour force), and a 2.56-point decline (95% CI -3.93 to -1.19, p<0.001) among those who had two or more spells of unemployment after adjusting for other variables. Findings for shifts from employment to 'not in the labour force' were in the same direction; however, effect sizes were smaller.

CONCLUSIONS

These results indicate that multiple spells of unemployment are associated with continued, though small, declines in mental health. Those who leave employment for reasons other than unemployment experience a smaller reduction in mental health.