Dobutamine-induced fever and isolated eosinophilic myocarditis in a 66-year-old male awaiting heart transplantation: a case report

A 66-year-old male with non-ischemic dilated cardiomyopathy who presented for decompensated heart failure and heart transplant evaluation had to be temporarily delisted from the transplant list due to fever. No infectious source was identified and drug fever was suspected. Dobutamine was discontinued and his fever subsequently defervesced. He eventually received an orthotopic heart transplantation without complication. Explanted heart showed eosinophilic myocarditis with pathologic features consistent with a drug-induced pattern of myocarditis. Throughout the hospital course, he did not develop peripheral blood eosinophilia to suggest eosinophilic myocarditis. The importance of this report is to have a greater awareness of dobutamine-induced fever and eosinophilic myocarditis even in patients without peripheral eosinophilia. In febrile patients receiving prolonged dobutamine infusion with no other evidence of infection, consideration should be given to discontinuing dobutamine or switching to an alternative inotrope such as milrinone.

Monte Carlo simulations of the relative biological effectiveness for DNA double strand breaks from 300 MeV u(-1) carbon-ion beams

Monte Carlo simulations are used to calculate the relative biological effectiveness (RBE) of 300 MeV u(-1) carbon-ion beams at different depths in a cylindrical water phantom of 10 cm radius and 30 cm long. RBE values for the induction of DNA double strand breaks (DSB), a biological endpoint closely related to cell inactivation, are estimated for monoenergetic and energy-modulated carbon ion beams. Individual contributions to the RBE from primary ions and secondary nuclear fragments are simulated separately. These simulations are based on a multi-scale modelling approach by first applying the FLUKA (version 2011.2.17) transport code to estimate the absorbed doses and fluence energy spectra, then using the MCDS (version 3.10A) damage code for DSB yields. The approach is efficient since it separates the non-stochastic dosimetry problem from the stochastic DNA damage problem. The MCDS code predicts the major trends of the DSB yields from detailed track structure simulations. It is found that, as depth is increasing, RBE values increase slowly from the entrance depth to the plateau region and change substantially in the Bragg peak region. RBE values reach their maxima at the distal edge of the Bragg peak. Beyond this edge, contributions to RBE are entirely from nuclear fragments. Maximum RBE values at the distal edges of the Bragg peak and the spread-out Bragg peak are, respectively, 3.0 and 2.8. The present approach has the flexibility to weight RBE contributions from different DSB classes, i.e. DSB0, DSB+ and DSB++.

A PC-based laparoscopic surgery skills training and assessment system

The purpose of this study is to build a cost-effective and easy-to-popularize laparoscopic training system based on improving traditional training box. The system has the capability of objective skills assessment and the function of automatic recording of training process and results, as well as 3-dimensional coordinate tracking of instruments. The results of pilot experiment in laparoscopic-assisted grip skill assessment had been shown the system can assess the different grip ability level between the senior surgeons and junior residents. Regarding to the evaluation of training effectiveness, five subjects without laparoscopic surgery experiences were asked to perform grip training for five days to observe their training curves. According to the experimental results, the total time taken for subject 1 to subject 5 are improved by 54.9%, 52.0%, 60.6%, 23.3%, and 63.5% separately.

A pilot validation of multi-echo based echo-planar correlated spectroscopic imaging in human calf muscles

A current limitation of MR spectroscopic imaging of multiple skeletal muscles is prolonged scan duration. A significant reduction in the total scan duration using the echo-planar correlated spectroscopic imaging (EP-COSI) sequence was accomplished using two bipolar readout trains with different phase-encoded echoes for one of two spatial dimensions within a single repetition time (TR). The second bipolar readout was used for spatially encoding the outer k-space, whereas the first readout was used for the central k-space only. The performance of this novel sequence, called multi-echo based echo-planar correlated spectroscopic imaging (ME-EPCOSI), was demonstrated by localizing specific key features in calf muscles and bone marrow of 11 healthy volunteers and five subjects with type 2 diabetes (T2D). A 3 T MRI-MRS scanner equipped with a transmit-receive extremity coil was used. Localization of the ME-EPCOSI sequence was in good agreement with the earlier single-readout based EP-COSI sequence and the required scan time was reduced by a factor of two. In agreement with an earlier report using single-voxel based 2D MRS, significantly increased unsaturated pools of intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) and decreased IMCL and EMCL unsaturation indices (UIs) were observed in the soleus and tibialis anterior muscle regions of subjects with T2D compared with healthy controls. In addition, significantly decreased choline content was observed in the soleus of T2D subjects compared with healthy controls. Multi-voxel characterization of IMCL and EMCL ratios and UI in the calf muscle may be useful for the non-invasive assessment of altered lipid metabolism in the pathophysiology of T2D.

Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: the women's health initiative

PURPOSE

Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of postmenopausal women.

METHODS

Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression.

RESULTS

Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR=1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR=1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant.

CONCLUSIONS

Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.

Cumulative risk assessment for plasticizer-contaminated food using the hazard index approach

Phthalates strongly and adversely affect reproduction, development and liver function. We did a cumulative risk assessment for simultaneous exposure to nine phthalates using the hazard index (HI) and the levels of nine phthalates in 1200 foodstuff samples. DEHP (di-2-ethylhexyl phthalate) present the highest level (mean: 0.443 mg/kg) in 1200 samples, and the highest average daily dose (ADD) was found in DEHP, ΣDBP(i + n) (the sum of dibutyl phthalate [DBP] isomers [DnBP + DiBP]) posed the highest risk potential of all the phthalates. In seven phthalates, the 95th percentiles of the ADDs for ΣDBP(i + n) in 0-6-yr-old children accounted for 91% (79-107%) of the tolerable daily intake, and the 95th percentiles of the HIs for the anti-androgenic effects of five phthalates in 0-3-yr-old children and 4-6-yr-old girls were >1. We conclude that the health of younger Taiwanese may be adversely affected by overexposure of phthalate-contaminated foods.

Clinical association of circulating VEGF-B levels with hyperlipidemia and target organ damage in type 2 diabetic patients

Vascular endothelial growth factor-B (VEGF-B is an important member of the VEGF protein family. Recent animal studies indicated that VEGF-B signaling had determinant roles in insulin resistance, lipid distribution and metabolism in type 2 diabetes. The clinical significance of VEGF-B in type 2 diabetes is still not clear. This study aimed to correlate VEGF-B levels with biochemistry characteristics and target organ damage in type 2 diabetic patients. Serum VEGF-B levels were measured using ELISA. A crosssectional control study, which included 180 type 2 diabetic patients and 62 healthy subjects, was carried out. Diabetic patients who were undergoing insulin therapy were not included. This results showed that serum VEGF-B levels did not differ between the type 2 diabetic patients and the healthy controls (169.2∓118.8 vs 163.5∓115.2 pg/mL; P=0.734). VEGF-B levels in type 2 diabetic patients were significantly associated with the levels of c-peptide, total cholesterol and triglyceride. T-test analysis showed that the associations of serum VEGF-B levels with insulin resistance, pancreatic reserve, HDL and LDL were not significant. Regression analysis showed that VEGF-B levels were significantly correlated with diabetic retinopathy and nephropathy. No significant association between VEGF-B and macro-vasculopathy was found. In conclusion, our study findings suggested that VEGF-B levels did not differ between the type 2 diabetic patients and the normal controls. High VEGF-B levels might correlate with the presence of hyperlipidemia and target organ damage in type 2 diabetic patients.

Comparison of NMOSFET and PMOSFET devices that combine CESL stressor and SiGe channel

Strained-Si technology could enhance the carrier mobility and improve the device performance. Contact-etch-stop-layer (CESL) structure with different stress and SiGe channel was fabricated with 90-nm technology. The electrical properties of N and PMOSFET devices combining CESL and SiGe channel were investigated. The short channel effects (SCE), such as drain-induced barrier lowering (DIBL), were also studied. Moreover, the stress contour in the SiGe channel has been simulated with TCAD to understand the relationship between stress distribution and device performance for different CESL structures. It is observed that the stress in the channel region was independent of the type of N or PMOSFET devices, but it was dependent on the CESL type and channel length. Based on the experimental and simulation results, it is confirmed that the device performance is associated with the stress in the channel, and the approach of CESL stressor and SiGe channel is shown to effectively improve the mobility of NMOSFETs and PMOSFETs.

Resistance training improves indices of muscle insulin sensitivity and β-cell function in overweight/obese, sedentary young men

We examined the effects of RT on oral glucose tolerance test (OGTT)-derived indices of muscle insulin sensitivity, hepatic insulin resistance, β-cell function, and skeletal muscle proteins related to glucose transport in overweight/obese, sedentary young men. Twenty-eight participants [median body mass index (BMI) 30.9 kg/m(2); age 22 yr] completed 12 wk of RT (3 sessions/wk) and were assessed for changes in OGTT-derived indices, resting metabolic rate, body composition, serum adipokines, and skeletal muscle protein content [hexokinase 2 (HK2), glucose transporter type 4 (GLUT4), RAC-β serine/threonine-protein kinase (AKT2), glycogen synthase kinase 3β, and insulin receptor substrate 1]. Individualized responses to RT were also evaluated. RT significantly improved insulin and glucose area under the curve (both P < 0.03). With the use of OGTT indices of insulin action, we noted improved muscle insulin sensitivity index (mISI; P = 0.03) and oral disposition index (P = 0.03). BMI, lean body mass (LBM), and relative strength also increased (all P < 0.03), as did skeletal muscle protein content of HK2, GLUT4, and AKT2 (26-33%; all P < 0.02). Hepatic insulin resistance index, adiponectin, leptin, and total amylin did not change. Further analysis demonstrated the presence of highly individualized responsiveness to RT for glucose tolerance and other outcomes. RT improved oral indices of muscle insulin sensitivity and β-cell function but not hepatic insulin resistance in overweight/obese young men. In addition to the increase in LBM, the improvements in insulin action may be due, in part, to increases in key insulin signaling proteins.

Smoking and diabetes: does the increased risk ever go away?

Recent studies reported that smoking cessation leads to higher short-term risk of type 2 diabetes than continuing to smoke. However, the duration of increased diabetes risk following smoking cessation needs further investigation. We followed 135,906 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative between September 1, 1993, and December 31, 1998, over an average of 11 years to examine the association between smoking cessation and risk of diabetes using Cox proportional hazard multivariable-adjusted regression models. Compared with that for never smokers, the risk for diabetes was significantly elevated in current smokers (hazard ratio = 1.28, 95% confidence interval: 1.20, 1.36) but was even higher in women who quit smoking during the first 3 years of follow-up (hazard ratio = 1.43, 95% confidence interval: 1.26, 1.63). Among former smokers, the risk of diabetes decreased significantly as the time since quitting increased and was equal to that of never smokers following a cessation period of 10 years. In new quitters with low cumulative exposure (<20 pack-years), diabetes risk was not elevated following smoking cessation. In conclusion, the risk of diabetes in former smokers returns to that in never smokers 10 years after quitting, and even more quickly in lighter smokers.

Resistance training increases SHBG in overweight/obese, young men

OBJECTIVE

Evidence suggests that SHBG affects glycemic control, predicts both T2D and metabolic syndrome, and is low in obese subjects. We sought to determine if resistance exercise training (RT) can increase sex hormone-binding globulin (SHBG) and ameliorate levels of related steroid hormones in overweight/obese, sedentary young men.

MATERIALS/METHODS

36 participants (BMI 31.4 kg/m(2), age 22 years) were randomized into an RT (12 weeks of training, 3/week) or control group (C, 12 weeks no training), and assessed for changes in SHBG, cortisol, testosterone, free testosterone (FT) and free androgen index (FAI). In addition, body composition and oral glucose tolerance testing was performed.

RESULTS

12 weeks of RT increased SHBG (P=0.01) and decreased FAI (P<0.05) and cortisol (P<0.05) compared to C. FT decreased in RT (P=0.01). Total testosterone did not change in either group. These changes were noted without weight loss, and in concert with increases in lean body mass (P=0.0002 vs C) and decreases in glucose area under the curve (AUC) (P=0.004), insulin AUC (P=0.03), and total (P=0.002) and trunk (P=0.003) fat mass in RT.

CONCLUSION

In overweight/obese young men, RT increases SHBG and lowers FAI in obese young adult men.

Correction of Wassel type IV thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation

The purpose of this study is to present a treatment algorithm and a method of flexor pollicis longus tendon relocation for Wassel type IV thumb duplication with zigzag deformity. Forty-two thumbs in 42 patients were included in this study and the mean follow-up was 4 years. In addition to excision of the extra digit, tendon relocation and metacarpal and/or proximal phalangeal osteotomy were carried out, based on the degree of angulation at the metacarpophalangeal and interphalangeal joints. Tendon relocation was achieved using our pull-out suture technique. The results were assessed using an evaluation form for thumb polydactyly provided by the Japanese Society for Surgery of the Hand. At the time of latest clinical contact, eight cases were rated good, 31 cases fair, and three cases poor. It is useful to decide surgical procedures according to the degree of angulation of the metacarpophalangeal and interphalangeal joints and flexor pollicis longus tendon relocation is important to prevent malalignment at the interphalangeal joint.

Development of a wearable system integrated with novel biomedical sensors for ubiquitous healthcare

The world's ageing population has led to an urgent need for long-term and patient-centered healthcare solutions. Hence, there is a growing need for wearable systems for physiologic monitoring. While various biosignals are monitored with traditional approaches, it is worthwhile to investigate alternative sensing techniques in order to improve accessibility and understanding of patients' conditions. This paper presents our laboratory's development of such a wearable system, which makes use of unconventional techniques for physiologic monitoring. With its integrated textile electrocardiogram (ECG) electrodes, intelligent finger-ring photoplethysmogram (PPG) sensor, miniaturized optical fiber-based temperature sensor, eye dynamics monitor, global positioning system (GPS) module, and wireless capability, it demonstrates a feasible solution for ubiquitous healthcare.

Cathelicidin protects against Helicobacter pylori colonization and the associated gastritis in mice

Cathelicidin, an antimicrobial peptide of the innate immune system, has been shown to modulate microbial growth, wound healing and inflammation. However, whether cathelicidin controls Helicobacter pylori infection in vivo remains unexplored. This study sought to elucidate the role of endogenous and exogenous mouse cathelicidin (CRAMP) in the protection against H. pylori infection and the associated gastritis in mice. Results showed that genetic ablation of CRAMP in mice significantly increased the susceptibility of H. pylori colonization and the associated gastritis as compared with the wild-type control. Furthermore, replenishment with exogenous CRAMP, delivered via a bioengineered CRAMP-secreting strain of Lactococcus lactis, reduced H. pylori density in the stomach as well as the associated inflammatory cell infiltration and cytokine production. Collectively, these findings indicate that cathelicidin protects against H. pylori infection and its associated gastritis in vivo. Our study also demonstrates the feasibility of using the transformed food-grade bacteria to deliver cathelicidin, which may have potential clinical applications in the treatment of H. pylori infection in humans.

Characterization of Intra-myocellular Lipids using 2D Localized Correlated Spectroscopy and Abdominal Fat using MRI in Type 2 Diabetes

A major goal of this pilot study was to quantify intramyocellular lipids (IMCL), extramyocellular lipids (EMCL), unsaturation index (UI) and metabolites such as creatine (Cr), choline (Ch) and carnosine (Car), in the soleus muscle using two-dimensional (2D) localized correlated spectroscopy (L-COSY). Ten subjects with type 2 diabetes (T2D), controlled by lifestyle management alone, and 9 healthy control subjects, were studied. In T2D patients only, the following measurements were obtained: body mass index (BMI); waist circumference (WC); abdominal visceral and subcutaneous fat quantified using breath-held magnetic resonance imaging (MRI); a fasting blood draw for assessment of glucose, insulin, and estimation of homeostasis model assessment of insulin resistance (HOMA-IR), HbA_1c, and high-sensitivity c-reactive protein (hs-CRP). Analysis of the soleus muscle 2D L-COSY spectral data showed significantly elevated IMCL ratios with respect to Cr and decreased IMCL UI in T2D when compared to healthy subjects (P < 0.05). In T2D subjects, Pearson correlation analysis showed a positive correlation of IMCL/Cr with EMCL/Cr (0.679, P < 0.05) and HOMA-IR (0.633, P < 0.05), and a non-significant correlation of visceral and subcutaneous fat with magnetic resonance spectroscopy (MRS) and other metrics. Characterization of muscle IMCL and EMCL ratios, UI, and abdominal fat, may be useful for the noninvasive assessment of the role of altered lipid metabolism in the pathophysiology of T2D, and for assessment of the effects of future therapeutic interventions designed to alter metabolic dysfunction in T2D.

Robust radial basis function neural networks

Function approximation has been found in many applications. The radial basis function (RBF) network is one approach which has shown a great promise in this sort of problems because of its faster learning capacity. A traditional RBF network takes Gaussian functions as its basis functions and adopts the least-squares criterion as the objective function, However, it still suffers from two major problems. First, it is difficult to use Gaussian functions to approximate constant values. If a function has nearly constant values in some intervals, the RBF network will be found inefficient in approximating these values. Second, when the training patterns incur a large error, the network will interpolate these training patterns incorrectly. In order to cope with these problems, an RBF network is proposed in this paper which is based on sequences of sigmoidal functions and a robust objective function. The former replaces the Gaussian functions as the basis function of the network so that constant-valued functions can be approximated accurately by an RBF network, while the latter is used to restrain the influence of large errors. Compared with traditional RBF networks, the proposed network demonstrates the following advantages: (1) better capability of approximation to underlying functions; (2) faster learning speed; (3) better size of network; (4) high robustness to outliers.

Site occupancy and magnetic properties of pyrochlore-structured AgOs2O6

AgOs(2)O(6) prepared from ion-exchanged superconducting β-pyrochlore KOs(2)O(6) has been shown to be non-superconducting. Synchrotron x-ray structure refinement suggests that AgOs(2)O(6) has the Ag ion mostly occupying the low-symmetry 32e site in the [Formula: see text] space group of proper occupancy, which is different from the original major occupancy at the high-symmetry 8b site for KOs(2)O(6), and similar to non-superconducting Na(1.4)Os(2)O(6)·H(2)O. Magnetic susceptibility measurements found no magnetic ordering down to ~1.7 K. The trace amount of isolated spins suggests that the Ag could be neutral and lead to a pure Os(6+) valence state of zero spin in the newly prepared AgOs(2)O(6).

Biochemical study of retired pentachlorophenol workers with and without following dietary exposure to PCDD/Fs

PCDD/Fs are found as impurities in commercial pesticide sodium pentachlorophenol (Na-PCP) salt. We compared, using multivariate logistic regression analysis adjusted for confounding factors, serum PCDD/F levels and biochemical examinations of retired Na-PCP workers and other inhabitants living near a closed Na-PCP plant that discharged PCP-contaminated wastewater into a nearby pond in Tainan, Taiwan. In this cross-sectional study from October 2006 through May 2009, 1167 participants were divided into groups according to their occupational (retired Na-PCP plant workers versus other residents) and dietary exposure (eating polluted fish versus not eating polluted fish) to PCDD/Fs, and a general population from a large-scale survey. Serum PCDD/F levels were significantly different between these groups (range: from 22.9±10.0pg WHO(98)-TEQ(DF) g(-1) lipid in the general population to 109.6±94.5pg WHO(98)-TEQ(DF) g(-1) lipid in retired Na-PCP workers eating polluted seafood; P(trend)<0.001). Distinct patterns of PCDD/Fs congener profiles, showing a significantly higher proportion of 1,2,3,7,8-PeCDD, 1,2,3,6,7,8-HxDD, and less 2,3,4,6,7,8-HpCDF, OCDF, were also found among workers and residents with different serum PCDD/F levels versus the general population. After adjusting for confounding factors, glucose (adjusted odds ratio [AOR] 7.22 [95% CI: 4.04-12.90]), triglycerides (AOR 4.31 [95% CI: 2.57-7.22]), blood urea nitrogen (AOR 2.90 [95% CI: 1.58-5.33]), creatine (AOR 5.83 [95% CI: 1.12-30.30]) and total protein (AOR 3.74 [95% CI: 1.91-7.31]) levels in retired workers were significantly higher than in the reference group. Occupational exposure to PCDD/Fs is associated with biochemical abnormalities that may persist for years after serum PCDD/F levels have declined.

Association analysis of dopaminergic gene variants (Comt, Drd4 And Dat1) with Alzheimer s disease

Defects in dopaminergic transmission play important roles in the disturbance of synaptic plasticity and even in advanced cognitive behavior. However, the relationship between genes involved in the regulation of dopamine levels and predisposition for Alzheimer s disease (AD) remains unclear. The potential association of dopamine-modulating gene polymorphisms with AD was evaluated. We performed a case-control study with 120 patients and 86 healthy controls. Two catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms (SNPs) (rs2020917 and rs4646312), two dopamine D4 receptor (DRD4) SNPs (rs3758653 and rs916455), and four dopamine transporter (DAT1) SNPs (rs2937639, rs6347, rs12516948 and rs11133762) were investigated. The T allele at the DRD4 SNP (rs3758653) was found to be significantly associated with AD. Our results also showed that haplotype frequencies, observed from the analyzed SNPs, were distributed significantly differently in AD patients vs control subjects. Moreover, a strong association was observed between the A allele at rs6347 of DAT1 and moderate stage of dementia. These observations suggest that genetic variations in the dopamine-modulating genes, COMT, DRD4 and DAT1, may contribute to AD pathogenesis in the Taiwanese population.

Frequent detection of plasmid-mediated quinolone resistance (qnr) genes in multidrug-resistant Enterobacteriaceae blood isolates, Hong Kong

Plasmid-mediated quinolone resistance (qnr) genes confer low-level resistance but provide background for selection of highly-resistant strains. We investigated their prevalence and significance in clinical Enterobacteriaceae bacteremic isolates in Hong Kong. A prospective, hospital-based study was conducted (January 2008 to March 2009). Consecutive, non-duplicate blood isolates of extended-spectrum-β-lactamase (ESBL) and/or plasmid-mediated AmpC (PMAmpC) β-lactamase-producing Enterobacteriaceae were collected and subjected to qnr genes detection using multiplex PCR. Direct sequencing was performed to characterize the qnr and the co-existing bla genes. Clinical and microbiological variables, including antimicrobial resistance profiles, were compared between infections by 'qnr-positive' and 'qnr-negative' Enterobacteriaceae. Altogether 199 ESBL/PMAmpC-producing Enterobacteriaceae isolates were studied. qnr genes were detected in 20 % (qnrB, n = 24; qnrS, n = 16; qnrA, n = 0), of which 85% were Klebsiella spp. There was a strong association with PMAmpC genes (qnrB and DHA-1; p < 0.001). 'qnr-positive' isolates were more commonly hospital-acquired (60.0% vs 35.8%; adjusted OR 2.68, 95%CI 1.32-5.46) and multidrug-resistant (e.g. amoxicillin-clavulanate 90-100%, piperacillin-tazobactam 40-57%, ceftazidime 53-78%; sulfamethoxazole/trimethoprim 60-70%; ciprofloxacin 53-65%, levofloxacin 35-48%). Patients with 'qnr-positive' Enterobacteriaceae bacteremia had a higher 30-day mortality (45% vs 22%, p = 0.003). High Pitt bacteremia score, development of pneumonia, and failure to receive susceptible fluoroquinolone (adjusted HR 4.27; 95%CI 1.45-12.61) or carbapenem (adjusted HR 3.04; 95%CI 1.49-6.20) treatment were independent factors associated with death. A high proportion of ESBL/PMAmpC-producing Enterobacteriaceae (typically Klebsiella) bacteremic isolates carried qnr. These strains were multidrug-resistant, which was associated with inappropriate treatment and high fatality. Further dissemination of qnr and selection of fluoroquinolone/β-lactam-resistant strains should be closely monitored and controlled.

Effect of oral phytoestrogen on androgenicity and insulin sensitivity in postmenopausal women

AIM

The aim of this study was to determine and compare the effect of treatment with transdermal oestrogen and phytoestrogen on insulin sensitivity and sex hormone-binding globulin (SHBG) levels in healthy postmenopausal women.

METHODS

Forty-three healthy postmenopausal women aged 68 ± 7 (mean ± SD) years who were not receiving hormonal replacement therapy completed a 3 month randomized drug therapy study. The participants were randomized to one of four groups: 0.05 mg or 0.1 mg transdermal oestrogen/day, or 40 or 80 mg oral phytoestrogen (Promensil)/day insulin sensitivity was indirectly measured using the quantitative insulin sensitivity check index (QUICKI). SHBG, total testosterone, oestradiol, and fasting glucose and insulin levels for calculation of insulin sensitivity were obtained at baseline and at monthly intervals during the 3 months of therapy.

RESULTS

In healthy nondiabetic postmenopausal women, the rate of change in QUICKI was significantly different between the red clover based phytoestrogen and transdermal oestrogen groups, so that after three months of therapy, QUICKI with red clover based phytoestrogen therapy was lower than that in the transdermal oestrogen group, p = 0.01. Red clover based phytoestrogen therapy was not associated with any changes in SHBG levels whereas transdermal estrogen therapy significantly increased SHBG levels, p = 0.05.

CONCLUSIONS

In contrast to transdermal oestrogen therapy, oral phytoestrogen therapy does not decrease androgenicity and is associated with a decrease in insulin sensitivity. These effects are similar to those of raloxifene and consistent with phytoestrogen's selective oestrogen receptor modulator properties.