Serum lipid profiles with and without CAD: Jordan Hyperlipidaemia and Related Targets Study (JoHARTS-1)

We measured fasting serum total cholesterol (TC), triglycerides (TG), and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) levels in 5000 individuals. Coronary artery disease (CAD) was present in 31%. Compared with women, men had lower mean TC, LDL-C and HDL-C and higher mean TG. Optimal TC level was observed in only 46% of men and 41% of women, and optimal TG in 42% of men and 50% of women. Only 3% of men and 12% of women had HDL-C > 60 mg/dL. Mean TC was not different in CAD patients and those without CAD, but mean TG was significantly higher and mean HDL-C was lower. In all age groups, low HDL-C was more prevalent among men and women who had CAD.

Échantillon d’instruments de mesure de la qualité de vie et de théories pour évaluer des services de psychiatrie

Un échantillon d'instruments de mesure de la qualité de vie est passé en revue pour les lecteurs qui veulent en déterminer la pertinence dans l'évaluation de services de psychiatrie. Tous les instruments sont explorés selon la manière d'y traiter amis et membres de la famille. Les instruments sont aussi évalués suivant leur position sur trois questions théoriques: l'utilisation des indicateurs objectifs et subjectifs de la qualité de vie; l'inclusion des états positifs de bien-être dans l'instrument de mesure; et le point de vue de l'instrument mesurant la qualité de vie. Chacune de ces questions est présentée. Position des auteurs: les indicateurs objectifs et subjectifs se complètent; il y a de grands avantages à mesurer les états positifs de bien-être tout comme les états négatifs; tous les points de vue sont valables, et il y a un risque à accepter un point de vue particulier, surtout d'une autre personne, comme standard de définition.

Subgroup analysis of efficacy and safety analysis of a randomized, double-blinded controlled phase II study of STA-4783 in combination with paclitaxel in patients with metastatic melanoma

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Background: STA-4783 (S), an inducer of heat shock protein 70 (hsp70) is a bis-thiobenzoylhydrazide compound. S leads to up-regulation of hsp70 in tumor cell lines. Xenograft models of solid tumors showed synergistic anti-tumor activity in combination with paclitaxel (P). The combination P + S, in phase I and II studies, showed dose-related hsp70 induction (evidence of biological activity) and tolerability. Methods: Eligibility was based on a diagnosis of metastatic cutaneous melanoma, ECOG <=2, and prior treatment with 1 or no chemotherapy regimens. A total of 81 patients (pts) were randomized 2:1 (P 80 mg/m2 + S 213 mg/m2:P 80 mg/m2) 3 weeks out of 4 at 21 US clinical sites. The primary endpoint was progression free survival (PFS); secondary endpoints were response rate (RR), and adverse events (AEs). Results: Based on intent-to-treat analysis, the median PFS was 3.68 months (m) for P + S vs. 1.84 m in the P only arm (p=.035). RR was 15.1% in the P + S arm and 3.6% in the P arm. Subgroup analysis showed chemo- naive pts (n=23) with P + S showed a median PFS of 8.28 m vs. 2.40 in the P arm (n=9). For pts with 1 prior chemotherapy, (n=29), PFS on P + S was 3.12 m vs. 1.77 m on P (n=19). Of 19 pts who crossed over at progression, data are available for 14. PFS ranged from 0.72 to 5.5 m. Three of the 14 evaluable pts treated with P alone had rapid progression (0.95, 1.6, and 1.7 m) then significant inversion of the time to progression with the addition of S to P (2.3, 5.5, and 4.2 m) suggesting study drug effect. Scans were done at identical intervals (8 weeks). The proportion of pts with AEs of grade 3 or higher was 54% (n=52) in the P + S group and 57% in the P group (n=28); pts on P received a median of 2 cycles, while pts in the P + S group received a median of 4. Adverse events leading to discontinuation were low in both groups: 10% for the P + S, and 14% for P. Conclusions: The addition of S to P showed an increase in PFS vs. P alone particularly in chemo-naïve pts. A few pts failing single agent P appeared to benefit from P + S. Despite the additional treatment duration in the P + S group the drugs were well- tolerated, and showed mainly P related adverse events. A phase III study is planned to confirm a role for P + S in metastatic melanoma.

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The concept of quasi-tissue-equivalent nanodosimeter based on the glow peak 5a/5 in LiF:Mg,Ti (TLD-100)

We demonstrate the viability of the concept of using existing molecular nanostructures in thermoluminescent solid-state materials as solid-state nanodosimeters. The concept is based on mimicking radiobiology (specifically the ionization density dependence of double strand breaks in DNA) by using the similar ionization density dependence of simultaneous electron-hole capture in spatially correlated trapping and luminescent centres pairs in the thermoluminescence of LiF:Mg,Ti. This simultaneous electron-hole capture has been shown to lead to ionization density dependence in the relative intensity of peak 5a to peak 5 similar to the ratio of double-strand breaks to single-strand breaks for low energy He ions.

Acoustic waves in cylindrical gap, filled by polymeric liquid

Propagation of acoustic waves in thin-walled elastic tube with coaxial internal rigid rod is investigated in conjugated quasi-one-dimensional formulation. The cylindrical gap between the tube's wall and the central rod is filled by polymeric liquid, described by hereditary model with a discrete spectrum. Dynamics of the tube is treated within Kirchhoff-Love approximation. The dispersion equation accounting for viscoelastic effects in the fluid in coupling with inertia, radial and longitudinal deformations of the tube's wall has been obtained. Its analysis has showed strong influence of the liquid's rheological properties and geometrical parameters of the system on pressure signals dispersion and attenuation. The results can be used for rheological characterization of polymeric liquids by acoustic means.

A physiological manoeuvre to improve the positivity of the gastro-oesophageal reflux scintigraphic test

One of the best examinations used routinely to detect gastro-oesophageal reflux (GOR) is scintigraphy and attempts are continuously being made to improve the performance of the test. We have tested a new manoeuvre to improve the results. Three hundred and twenty eight patients (190 males and 138 females, aged 1 month to 84 years, average 4.47 years) were studied after a 12 h fast period with 100 MBq of 99Tcm-phytate, 50 ml volume, directly delivered into the stomach in a mixture of orange juice. All patients were strongly suspected of having GOR. Conventional acquisition was done for 20 min, at a rate of one frame every 20 s. In the middle of the examination, small children were put in the upright position and held there for a few seconds or released in a way that allowed movement; adults were asked to stand up and walk a few metres. The test was then continued for the remaining 10 min. The global index of positivity was 64.6% (76 positive cases in the first half of the examination and 134 positive cases only after the manoeuvre). The mean of GOR episodes observed in the positive cases without the manoeuvre was 0.5 per patient, significantly different from the mean of 1.59 noted after the manoeuvre (P<0.01). In 28 cases the manoeuvre increased either the intensity or the frequency of reflux previously detected without it. We believe that this manoeuvre should be performed in all scintigraphic tests aiming to detect GOR. In the present series, the manoeuvre increased the frequency of GOR episodes.

Free radical production by antibiotic-killed bacteria in the guinea pig middle ear

OBJECTIVES

Oxygen free radicals are implicated in the pathogenesis of otitis media Recent investigations with animal models have demonstrated that free radical-mediated damage of the middle ear mucosa, measured as lipid hydroperoxide, occurs when the middle ear cavity is inoculated with Streptococcus pneumoniae. The present study was conducted to examine the effect of antibiotics on free radical-mediated damage in pneumococcal acute otitis media.

STUDY DESIGN

Animal model of acute otitis media.

METHODS

Seventy-eight guinea pigs underwent bilateral middle ear inoculation with 100 microl of 1) sterile saline as a control, 2) 50 microg/mL amoxicillin, 3) 10(7) colony forming units (CFU)/mL Streptococcus pneumoniae killed with 50 microg/mL amoxicillin, or 4) 10(7) CFU/mL S. pneumoniae. Animals were killed on postoperative day 1 or 5, and the middle ear mucosa was examined for lipid peroxidation as evidence of free radical damage.

RESULTS

Mucosal lipid hydroperoxide was significantly elevated compared with control subjects on day 1 in both the antibiotic-killed S. pneumoniae group and the S. pneumoniae-infected group. On day 5, the S. pneumoniae-infected mucosa had significantly higher lipid hydroperoxide levels compared with the antibiotic-killed group and the control subjects. Histological studies confirmed mucosal edema and the presence of inflammatory cells in the infected groups.

CONCLUSIONS

Antibiotic-killed bacteria seem to produce free radical-mediated damage to the middle ear mucosa in the early phase of acute otitis media. The clinical implication of this study is that free radical damage to the middle ear mucosa may occur in otitis media despite appropriate antibiotic therapy.

Tongue lesions in the pediatric population

OBJECTIVE

To describe the spectrum of pediatric tongue lesions treated surgically at Columbia-Presbyterian Medical Center from January 1990 to December 1999.

STUDY DESIGN AND SETTING

Retrospective case-series at the pediatric hospital of a tertiary care, academic medical center.

RESULTS

Seventeen patients were identified. Their ages ranged from 1 to 132 months (median, 7 months). Eight lesions were located anteriorly: mucous cyst (1), polyp (1), chronic inflammatory mass (1), hamartoma (1), squamous papilloma (2), cavernous hemangioma (1), and vascular malformation (1). Four lesions were located posteriorly: teratoma (1), glial choristoma (1), osseous choristoma (1), and benign epithelial cyst (1). Finally, there were 5 diffuse lesions including macroglossia (4) and massively infiltrating congenital lymphatic malformation (1). Symptoms included respiratory distress (3) and dysarthria (3); all other children were asymptomatic.

CONCLUSIONS

This series revealed an interesting spectrum of rare solid tumors; compared with other large series, fewer lymphatic and vascular malformations were seen. Presenting symptoms, differential diagnosis, and surgical approach were differentiated according to lesion location.

Bone scintigraphy in testicular tumors

PURPOSE

Testicular tumors do not occur frequently. Primary treatment is surgical, and radiotherapy and chemotherapy can play important roles in cases of metastatic disease. Bone scintigraphy is used largely for early detection of skeletal metastases from several tumors, and conventional radiographic studies are less sensitive than the nuclear technique for such a purpose. The aim of this study was to identify the role of bone scintigraphy in cases of testicular tumors, regardless of the grade.

MATERIALS AND METHODS

The authors examined 28 patients (8 to 52 years old) with proved testicular tumors using Tc-99m MDP (750 MBq; 20 mCi) injected intravenously. Whole-body images were obtained 2 hours later, at 500,000 counts per image. Radiographic studies were obtained to investigate abnormal areas noted on scintigraphy.

RESULTS

The results of bone scintigraphy were abnormal in seven cases, consisting of variable but diffuse uptake in the iliac bone on the same side as the affected testicle. MDP uptake was substantial in five of these patients (four seminomas, one nonseminoma; only two radiographic studies were abnormal), and the two other patients had moderate uptake of the radiopharmaceutical (two seminomas; radiographic studies were normal). Metastases were confirmed by biopsy in three cases.

DISCUSSION

Early metastases from seminomas can occur through the lymphatic drainage toward the iliac lymph node chain. This could explain these findings. The scintigraphic aspects of the affected iliac bones seem characteristic.

CONCLUSIONS

Early detection of metastases is very important to ensure the efficacy of radiotherapy and chemotherapy. Bone scintigraphy may play an important role in such cases and seems to be more sensitive than conventional radiography. Testicular tumor metastases should be considered when iliac involvement is observed. Paget's disease should be included in a differential diagnosis.

Tethered bisubstrate derivatives as probes for mechanism and as inhibitors of aminoglycoside 3'-phosphotransferases

Aminoglycoside 3'-phosphotransferases [APH(3')s] phosphorylate aminoglycoside antibiotics, a reaction that inactivates the antibiotics. These enzymes are the primary cause of resistance to aminoglycosides in bacteria. APH(3')-Ia operates by a random-equilibrium BiBi mechanism, whereas APH(3')-IIIa catalyzes its reaction by the Theorell-Chance mechanism, a form of ordered BiBi mechanism. Hence, both substrates have to be present in the active site prior to the transfer of phosphate by both mechanisms. Four bisubstrate analogues, compounds 1-4, were designed and synthesized as inhibitors for APH(3')s. These compounds are made of adenosine linked covalently to the 3'-hydroxyl of neamine (an aminoglycoside) via all-methylene tethers of 5-8 carbons. The K(i) values measured for these compounds indicated that affinities of APH(3')-Ia and APH(3')-IIa for compounds 2 and 3 (six- and seven-carbon tethers, respectively) were the best, and the inhibition constants for the two were comparable.

Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device: comparison with first, second and third generation devices. International Buttoned Device Trial Group

OBJECTIVES

The purpose of this study was to assess safety and effectiveness of the fourth generation buttoned device in dosing atrial septal defects (ASDs) and to test the hypothesis that introduction of double button reduces unbuttoning rate without reducing effectiveness.

BACKGROUND

Because of the high unbuttoning rate (7.2%) with first, second and third generation buttoned devices, the device was modified (fourth generation) so that there were two radiopaque spring buttons 4 mm apart on the button loop attached to the occluder.

METHODS

During a four-year period ending in September 1997, 423 patients, ages 1.5 to 80 years (median 16 years), underwent closure of ASD at 40 medical centers around the world.

RESULTS

The ASD size varied between 5 and 30 mm (median 17 mm). The device size varied between 25 and 60 mm. Unbuttoning occurred in 4 (0.9%) of 423 patients. Effective occlusion, defined as no (n = 343) or trivial (n = 34) residual shunt on echo-Doppler studies performed within 24 h of the procedure, was demonstrated in 377 patients (90%). Thus, the unbuttoning rate (0.9 vs. 7.2%) decreased (p<0.01) while effective occlusion rate (90 vs. 92%) remained unchanged (p>0.1) with this device, compared with earlier generation devices. During follow-up from one month to five years (23+/-15 months), 21 (5%) of 417 patients required surgical (n = 12) or transcatheter (n = 9) reintervention, mostly to treat significant residual shunt. In the remaining patients there was gradual reduction and disappearance of the residual shunt. No wire integrity problems were observed.

CONCLUSIONS

These data suggest that the fourth generation buttoned device is as effective as earlier generation devices, but without significant unbuttoning. Follow-up results remained good, with a reintervention-free rate of 89% at five years.

Nonsusceptible Streptococcus pneumoniae in children with chronic otitis media with effusion and recurrent otitis media undergoing ventilating tube placement

CONTEXT

Children with chronic otitis media are at risk for nonsusceptible Streptococcus pneumoniae (NSP) infection. If these children undergo ventilating tube placement, there is an opportunity to culture middle ear fluid and the nasopharynx to determine carriage of NSP.

OBJECTIVE

To determine the incidence of NSP carriage, NSP antibiotic susceptibility and risk factors for NSP carriage in children with chronic otitis media undergoing tube placement.

DESIGN AND SETTING

Prospective cohort study in an academic medical center with recruitment of patients from an otolaryngology private practice and clinic.

PATIENTS

Children < 18 years of age undergoing tube placement for chronic otitis media.

INTERVENTIONS

Myringotomy and tube placement, with culture of middle ear fluid and nasopharynx.

MAIN OUTCOME MEASURES

The incidence of NSP cultured from the middle ears and nasopharynx of recruited subjects with the use of the minimum inhibitory concentration break points for penicillin susceptibility recommended by the National Committee for Clinical Laboratory Standards.

RESULTS

S. pneumoniae was identified in at least 1 site from 23 of 300 study subjects (7.6%); of these 23, 12 case subjects (52.2%) harbored NSP. Of the risk factors assessed by preoperative questionnaire, only younger age was associated with NSP colonization (P < 0.0001). Of the six oral cephalosporins studied, cefpodoxime and cefuroxime showed good in vitro activity against S. pneumoniae isolates with intermediate penicillin resistance.

CONCLUSIONS

Children with chronic otitis media undergoing tube placement may carry NSP and provide a means of monitoring the incidence of NSP and antibiotic susceptibilities for children with ear infections in their communities. Younger age is a risk factor for NSP carriage in this population.

Acoustic waves in thin-walled elastic tube with polymeric solution

Acoustic waves in a pipe with polymeric liquid are investigated within a quasi-one-dimensional approach. Analysis of the dispersion equation has shown that rheological features lead to essential changes in both attenuation and speed of the sound. The results may find application in acoustic rheometry of polymeric liquids and for modeling of fast dynamic processes in polymer production technology.