Serum lipid profile in an elderly Chinese population

The serum lipid profile of a cohort of Hong Kong Chinese subjects living in the community (160 men, 154 women, mean age 70.2 +/- 11.4 years) was examined to determine the influence of age, sex, indices of obesity, drugs, smoking, alcohol intake, and presence of diabetes mellitus on serum lipid, lipoprotein, and apolipoprotein concentrations. A high waist/hip ratio (an index of central obesity) was associated with higher serum triglyceride and lower apolipoprotein (apo) A-I concentrations, while a higher body mass index was associated with lower high density lipoprotein (HDL) cholesterol and higher apo B concentrations. Smokers and those taking beta-blockers had lower apo A-I concentrations. Subjects on methyldopa had higher triglyceride and very low density lipoprotein cholesterol, with lower HDL and HDL2 cholesterol. All the HDL fractions were lower in diabetic subjects, and cholesterol and triglyceride concentrations correlated with indices of glycemic control.

Acute and long-term changes in serum lipids after acute stroke

We studied serum lipid profiles in 171 patients less than or equal to 48 hours after the onset of acute stroke and 3 months later. The 83 patients suffering cerebral infarction had significantly higher serum concentrations of total cholesterol, low density lipoprotein-cholesterol, and apolipoprotein B and significantly lower serum concentrations of triglycerides and lipoprotein (a) less than or equal to 48 hours after ictus than 3 months later. The lipid profiles of the 53 patients suffering lacunar infarction were similar on both occasions, the only significant differences being higher total cholesterol and low density lipoprotein-cholesterol concentrations less than or equal to 48 hours after ictus. No significant changes were observed among the 35 patients suffering cerebral hemorrhage apart from a significantly higher concentration of high density lipoprotein3-cholesterol less than or equal to 48 hours after ictus. Our study, with many patients classified according to stroke subtype, gives results different from those of previous studies with much fewer patients. We conclude that in studies of serum lipid and lipoprotein concentrations as risk factors for cerebral infarction, comparing values obtained less than or equal to 48 hours after admission with control values may incorrectly identify certain lipid fractions as risk factors.

FK506--its influence on anti-class 1 MHC alloantibody responses to blood transfusions

The influence of FK506 on in vivo alloantibody responses to major histocompatability class 1 antigens was investigated in inbred rat strains, and compared with the effect of cyclosporine. AO rats received transfusions of DA blood on days 0 and 7. From days 0 to 14 the rats also received, daily, either FK506 0.3 mg/kg suspended in saline or dissolved in olive oil, or CsA 10 mg/kg. The administration of FK506 suspended in saline at the time of blood transfusion completely abrogated the development of anti-MHC class 1 alloantibodies as detected by indirect hemagglutination (IHA)* and 51Cr release complement dependent cytotoxicity assays (CDC). Isotyping studies showed that FK506 suspended in saline suppressed IgM production and inhibited the switch to IgG production. Similar responses were seen in CsA-treated animals. In contrast, rats treated with FK506 dissolved in olive oil developed high titers of anti-class 1 alloantibodies. On days 49 and 56 the rats were challenged with further DA blood transfusions given without immunosuppression. In the groups given FK506 suspended in saline or CsA, cytotoxic antibodies did not develop; low titer antibodies were, however, detected by IHA in the animals that had previously received FK506 suspended in saline. The results indicate that FK506, in common with CsA, inhibits anti-class 1 MHC alloantibody production, and at the same time enables the development of tolerance. The vehicle in which FK506 is administered is, however, critical to its efficacy at the low doses used. These results may be of relevance to clinical transplantation as similar antibodies mediate hyperacute renal allograft rejection in man.

An echocardiographic assessment of asymptomatic elderly women with radiological cardiac enlargement

To determine the significance of increased cardiothoracic ratio in elderly women without hypertension, symptoms or signs of cardiac disease, echocardiographic measurements from 22 elderly women (mean age 75.1 +/- 3.9 years) with increased cardiothoracic ratio (mean ratio 0.59 +/- 0.04), were compared with those from 21 women (mean age 75.3 +/- 5.6 years) with normal cardiothoracic ratio using M-mode, cross-sectional and Doppler echocardiography. Subjects with increased cardiothoracic ratio had greater left ventricular end diastolic dimension and volume, and greater right ventricular diastolic dimension (P less than 0.05). There was no difference in all other cardiac dimensions, nor in the ejection fraction and fractional shortening. Thirty-three to sixty-four percent of subjects in both groups had increased thickness of the septum and left ventricular posterior wall. Regurgitation at one or more valves on Doppler examination occurred in 91% of subjects with abnormal and 86% of subjects with normal cardiothoracic ratio. Compared to a group of 43 healthy young female subjects (mean age 27.9 +/- 6.3 years), elderly subjects had thicker interventricular septum and left ventricular posterior wall, increased left atrial and aortic root size, greater mitral valve A:E ratio, and higher frequency of valvular regurgitation detected by Doppler. The ejection fractions in elderly and young subjects, however, were similar. It is concluded that, in the majority of cases, increased cardiothoracic ratio in asymptomatic normotensive elderly women with normal physical examination and electrocardiogram is unlikely to represent cardiac pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of FK-506 and low-concentration ciclosporin on human lymphocyte activation antigen expression and blastogenesis: a flow cytometric analysis

The influence of FK-506 and ciclosporin (CsA), either alone or in combination, on PHA- and alloantigen-induced human blood lymphocyte transformation was investigated. The concentrations of FK-506 and CsA required to cause 50% inhibition of mitogen-induced thymidine incorporation were 1.0 and 200 ng/ml respectively. Evidence of synergistic inhibition of DNA synthesis was obtained when doses of each drug below these concentrations were combined (FK-506, less than or equal to 0.5 ng/ml; CsA less than or equal to 50 ng/ml). In contrast, FK-506 and CsA failed to inhibit PHA-induced increases in cell size and granularity determined by flow cytometric analysis at 1 and 3 days of culture. Moreover, no significant changes in the expression of the interleukin 2 receptor (IL-2R; CD25), transferrin receptor (TR; CD71) or HLA-DR were observed in terms of percentage positive lymphocytes or mean cell surface membrane fluorescence intensity. In primary mixed lymphocyte cultures, 50% inhibition of thymidine incorporation was obtained with FK-506 and CsA concentrations of approximately 0.25 and 25 ng/ml respectively. Evidence of synergy was obtained when lower doses of each drug were combined (FK-506, less than or equal to 0.1 ng/ml; CsA less than or equal to 2 ng/ml). On their own, these concentrations of CsA were ineffective. In contrast to corresponding PHA-stimulated cells, FK-506-treated alloactivated lymphocytes exhibited reductions in IL-2R, TR and HLA-DR antigen expression, which in the cases of IL-2R and TR were further reduced by combination of FK-506 with low-concentration CsA. These data provide further evidence of the potential of combined low-dosage FK-506 and CsA for the control of human T-cell activation and proliferation in response to allostimulation.

Intake and blood levels of some minerals in an elderly Chinese population

Twenty-four hour intakes of potassium, calcium, and iron, and plasma concentration of potassium, copper and zinc were determined in a cluster sample of 400 apparently healthy subjects aged 60 years and over living in the community. Potassium and calcium intakes were lower in older men and lower in men compared to women. Both were much lower than intakes reported among Caucasian elderly, while iron intakes are comparable. Plasma potassium concentration was lower than values from studies of all ages and from studies of Caucasian elderly subjects. Copper and zinc concentrations were comparable to published values for adults of all ages. The significance of low potassium and calcium intake among elderly subjects in the population is discussed.

Risk factors predisposing to stroke in an elderly Chinese population--a longitudinal study

A cohort of 427 (171 males, 256 females) elderly Chinese aged 60 years and over whose health status had been defined in a previous survey was reexamined after a 30-month period to determine the occurrence of stroke. Subjects who initially had a history of transient ischemic attacks (TIA) and nonrheumatic atrial fibrillation had a greater than 10-fold increased risk of stroke in the subsequent 30 months. Men, smokers, alcohol drinkers, overweight subjects, and diabetics, also had a relative risk greater than one, but this did not reach statistical significance. Hypertensive subjects did not have an increased risk of stroke. It is concluded that the most important risk factors in the elderly predisposing to stroke in the short-term are a history of TIA and atrial fibrillation. Preventive measures against these two conditions may have a greater short-term impact in the elderly in reducing stroke occurrence than modification of other risk factors. Further studies involving larger numbers are needed to confirm these findings.

Biochemical predictors for osteoporotic fractures in elderly Chinese--a longitudinal study

In a longitudinal study of 283 elderly subjects aged 60 years or over living in the community, 9 subjects (7 women and 2 men) developed osteoporosis-related fractures in 30 months. These subjects initially had higher random urinary hydroxyproline/creatinine and calcium/creatinine ratios, and lower plasma 25-hydroxyvitamin D concentrations. These biochemical variables may be useful predictors of osteoporosis-related fractures and may provide a suitable community screening method to identify those most at risk.

Immunosuppressive activity of FK-506 in rats: flow cytometric analysis of lymphocyte populations in blood, spleen and thymus during treatment and following drug withdrawal

Rats were immunized systemically with sheep red blood cells (SRBC) and given either FK-506 (1 mg/kg) or drug vehicle by i.m. injection for 7 days. In animals receiving FK-506, there was suppression (87%) of the splenic plaque-forming cell response on day 4 and marked reductions in the serum antibody titre throughout the 3-week period following immunization. Sequential flow cytometric analyses of blood lymphocytes revealed statistically significant attenuation, by FK-506, of the increase in relative numbers of OX-12+ (B) cells between days 4 and 7. Following drug withdrawal, OX-12 values remained elevated, whereas in control animals a decline was observed. These changes were reflected in concomitant increases in the relative numbers of OX-19+ (CD3+), W3/25+ (CD4+) and OX-8+ (CD8+) T cells; however, due to an overall reduction in lymphocytes by day 7, absolute values were not significantly affected compared with controls. The pattern of changes in OX-6+ (MHC class II+) cells in blood was similar to that observed for B cells. FK-506 also suppressed increases in the small proportion of blood-borne OX-40+ (activated CD4+) cells and OX-39+ (interleukin-2 receptor+) cells in the 7 day period following immunization; thereafter values for activation marker expression between treatment and control groups were similar. In the spleen, there were fewer significant differences between FK-506 and control groups in the incidences of cells expressing the above markers. OX-8+ cells, however, were significantly higher in drug-treated animals on day 7, and there were also reductions in the small proportions of OX-39+ and OX-40+ cells when compared with controls. In the thymus, reversible medullary atrophy induced by FK-506 was accompanied on day 7 by increases in the incidence of CD4+ and CD8+ cells and by a concomitant reduction in OX-44+ mature, medullary thymocytes. Two weeks after drug withdrawal, the phenotypic marker expression profile had been restored to normal in blood, spleen and thymus. These data provide new information on the apparent capacity of FK-506 to interfere with T cell maturation and its influence on lymphocyte activation in vivo.

A case control study of some hematological and biochemical variables in acute stroke and their prognostic value

Hematocrit, total white cell and platelet counts, plasma urea and creatinine concentrations were estimated in 291 patients (mean age 70 +/- 12 years) admitted consecutively over a 6-month period to a district general hospital with acute stroke. Urinary albumin/creatinine ratio was also determined in a subgroup of patients during a follow-up visit 3 months after ictus. Results were compared with those from age- and sex-matched community controls. Total white cell count was elevated in all types of stroke compared with values from control subjects. Platelet count, plasma urea and creatinine concentrations were higher and the plasma albumin/globulin ratio was lower among patients with ischemic stroke. Elevated total white cell count, urea and creatinine, which were of prognostic significance, were found to be associated with the severity of stroke as indicated by the Glasgow coma score, and did not have any independent prognostic value. Elevated hematocrit was not shown to be a risk factor and did not have any prognostic significance. A low plasma albumin/globulin ratio, an index of plasma viscosity, was a possible risk factor for ischemic strokes. Urinary albumin/creatinine ratios in the highest quintile increased the risk of stroke 13-fold.

A comparison of biochemical indices of bone turnover in elderly institutionalized and free-living subjects

Plasma concentrations of calcium-phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25(OH)D) and albumin, and fasting urinary sodium/creatinine (Na/Cr), calcium/creatinine (Ca/Cr) and hydroxyproline/creatinine (HPr/Cr) were measured in a survey of 208 Chinese elderly subjects living in chronic care institutions, and compared with values from free-living elderly subjects. Plasma parathyroid hormone estimations were also performed on a subpopulation of women living in an institution. Subjects in institutions had higher urinary HPr/Cr ratios in both men and women, as well as higher urinary Ca/Cr ratios in women, suggesting increased bone resorption. These values show significant variation depending on the degree of mobility. Factors which could contribute to the increased bone loss among institutionalized subjects are: reduced physical activity, reduced exposure to sunlight and hence reduced plasma 25(OH)D concentrations, low calcium intake, protein calorie malnutrition and possibly higher sodium intake. Correction of these factors may reduce the risk of fractures among the elderly living in chronic care institutions.

Biochemical predictors of short term mortality in elderly residents of chronic care institutions

A survey of 208 elderly subjects living in four long term care institutions was undertaken over three months to identify nutritional and other variables that could be used to predict mortality during the subsequent three months. There were 58 men (mean age (SD) 75.6 (9.6) years) and 150 women (79.5 (8.4) years). Twenty nine subjects died (12 men and 17 women) within three months of completing the study. Twenty eight out of 57 variables differed significantly between those who died and those who survived. Subjects who died had lower systolic blood pressure, poorer intake of protein calories, lower concentrations of haemoglobin, plasma retinol, zinc, total cholesterol, and higher albumin adjusted plasma calcium concentrations. Stepwise regression analysis identified five variables that predicted mortality: plasma fructosamine; transferrin; glycosylated haemoglobin; prealbumin; and haemoglobin. The sensitivity, specificity, and predictive values of the discriminant function score using 0 as the demarcation between survivors and non-survivors were 75%, 97%, and 95%, respectively. This score could therefore be used to identify those most in need of nutritional support.

Epidemiologic study of Parkinson's disease in Hong Kong

In our cross-sectional survey of the residents of homes for the elderly in 2 Hong Kong districts--Shatin and Tai Po--we found that 3.4% of the subjects had Parkinson's disease (PD). There was no sex difference in the disease rate. We also conducted a case-control study to determine the associated factors of PD. We found that subjects with residence of long duration in rural areas, with engagement in farming, with previous use of herbicides and pesticides, and with habitual consumption of raw vegetables had a statistically significantly increased risk of PD. This study tends to support the hypothesis that environmental factors directly or indirectly related to agricultural activities are associated with the development of PD.

Anti-schistosomal activity of cyclosporin A: studies on murine spleen cells and the influence of a cyclosporin antagonist on resistance to infection

Mice were treated with 5-day courses of cyclosporin A (CsA) around the time of infection with Schistosoma mansoni. Recovery of lung-stage worms 4-8 days post-infection (p.i.) was substantially reduced (80%) and no sexually mature adults were recovered from the hepatic portal system at 7 weeks p.i. Flow cytometric analysis of spleen cells from CsA-treated animals during the period of maximal parasite attrition revealed transient reductions in CD3+ and CD4+ cells and in the CD4+: CD8+ ratio compared with drug vehicle-treated, infected controls. No significant numerical changes in B cells, macrophages or eosinophils were detected relative to vehicle-treated infected mice. Transfer of spleen cells from CsA-treated donors 8 days after infection failed to confer increased resistance to S. mansoni infection on untreated recipients. Moreover, concomitant administration of CsA and an inducer of interleukin-2 production (ADA-202-718) did not interfere with the anti-schistosomal effect of CsA. Despite our incomplete understanding of the in vivo properties of CsA and reports of its paradoxical effects on immune responses, these new data indicate that the influence of CsA in schistosomiasis is unlikely to be mediated by modulation of host cell mediated immunity. This contrasts with certain other anti-parasitic effects of CsA which appear to be mediated by an action on T cells.

Alleviation of cyclosporin-induced immune suppression by the cytokine inducer ADA-202-718

ADA-202-718 (ADA) has been shown to augment the production of various cytokines (IL-1, IL-2 and gamma-interferon) by murine T lymphocytes. Administration of 1 mg/kg/day to mice from the time of immunization significantly enhanced delayed-type hypersensitivity responses to sheep red blood cells (SRBC). ADA also inhibited immune suppression in mice given 25 but not 50 mg/kg/day cyclosporin A (CsA). There were, however, few changes compared with vehicle-treated controls in the numbers of splenic regulatory T cell subsets (L3T4+ and Ly2+) following treatment with CsA, ADA or both drugs. On the other hand, splenic lymphocytes from ADA-treated animals exhibited augmented proliferative responses to polyclonal T and B cell mitogens and antigen. ADA (1 mg/kg) also stimulated the splenic IgM plaque-forming cell response to SRBC and prevented CsA (25 mg/kg)-induced suppression of humoral immunity. In vitro, ADA (2 micrograms/ml) inhibited CsA-induced suppression of T cell proliferation, the effect being most marked at lower inhibitory concentrations of CsA. These data illustrate the capacity of ADA to augment or restore T cell responses in experimental animals and are consistent with the view that CsA acts in these experimental in vivo systems by inhibition of cytokine production.