Synergistic antitumor effect of TRAIL and adriamycin on the human breast cancer cell line MCF-7

The aim of the present study was to determine the effect of the combination of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and adriamycin (ADM) on the human breast cancer cell line MCF-7 and to identify potential mechanisms of apoptosis. Cell viability was analyzed by the MTT assay and the synergistic effect was assessed by the Webb coefficient. Apoptosis was quantified using the annexin V-FITC and propidium iodide staining flow cytometry. The mRNA expression of TRAIL receptors was measured by RT-PCR. Changes in the quantities of Bax and caspase-9 proteins were determined by Western blot. MCF-7 cells were relatively resistant to TRAIL (IC50 >10 microg/mL), while MCF-7 cells were sensitive to ADM (IC50 <10 microg/mL). A subtoxic concentration of ADM (0.5 microg/mL) combined with 0.1, 1, or 10 microg/mL TRAIL had a synergistic cytotoxic effect on MCF-7 cells, which was more marked with the combination of TRAIL (0.1 microg/mL) and ADM (0.5 microg/mL). In addition, the combined treatment with TRAIL and ADM significantly increased cell apoptosis from 9.8% (TRAIL) or 17% (ADM) to 38.7%, resulting in a synergistic apoptotic effect, which is proposed to be mediated by up-regulation of DR4 and DR5 mRNA expression and increased expression of Bax and caspase-9 proteins. These results suggest that the combination of TRAIL and ADM might be a promising therapy for breast cancer.

Recombinant human growth hormone improves survival and protects against acute lung injury in murine Staphylococcus aureus sepsis

OBJECTIVE

To investigate whether recombinant human growth hormone (rhGH) reduces mortality and protects against Staphylococcus aureus sepsis-induced acute lung injury.

METHODS

The bacteria-positive rate of blood smears and bacteria colony counts in bacteria plate culture, TNFalpha and IL-10 plasma levels, lung injury score, expression of intercellular adhesion molecule-1 (ICAM-1) as well as activation of nuclear factor-kappa B (NF-kappaB) in the lungs were determined 6, 12 and 24 h after 140 KM mice were injected with physiologic saline (i.p. group C, n = 20); S. aureus E311122 (1.75 x 10(12) cfu/L, 40 ml/kg, i.p. group S, n = 60); or S. aureus (as group S) with a subsequent treatment of rhGH (1.0 U kg(-1) day(-1)), i.m. group T, n = 60). The cumulative survival rate of an additional 15 mice from each group was followed for 7 days post S. aureus injection.

RESULTS

rhGH treatment significantly increased IL-10 plasma levels and the 7-day cumulative survival rate, whereas the bacteria-positive rate of blood smears, bacteria colony counts in bacteria plate cultures, lung injury score, ICAM-1 and NF-kappaB expression in the lungs were significantly reduced. In addition, rhGH treatment significantly suppressed the S. aureus sepsis-induced elevation of TNFalpha plasma levels.

CONCLUSIONS

These results indicate an ability of rhGH to prevent S. aureus sepsis-induced acute lung injury in mice, which may be attributed to attenuation of increased plasma TNFalpha levels, and elevated IL-10 plasma levels as well as reduced ICAM-1 expression and inhibited NF-kappaB activity in the lungs.

A clinical study of 115 patients with extranodal natural killer/T-cell lymphoma, nasal type

AIMS

To investigate the clinicopathological features, treatment outcomes, and prognostic factors in patients with extranodal natural killer (NK)/T-cell lymphoma, nasal type.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 115 patients diagnosed with extranodal NK/T-cell lymphoma, nasal type who were admitted to our hospital between January 1991 and June 2006.

RESULTS

In total, 107 patients were available for follow-up. After the completion of treatment, 48 patients (44.9%) achieved a complete remission. By the end of the follow-up period, 60 patients (56.1%) had died from local recurrence or metastases. The mean survival duration was 70.0 months, the median survival duration was 42 months, and the 5-year survival rate was 39.4%. The mean survival durations of the three treatment groups of chemoradiotherapy, radiotherapy and palliative treatment were 91.6, 60.1 and 17.6 months, respectively. The median survival durations were 72.0, 42.0 and 10 months, respectively. Patients treated with > 50 Gy had better local control and survival than the < 50 Gy group. However, there was no significant difference between patients having fewer than four cycles of chemotherapy and patients having more than four cycles. Multifactor Cox regression model analysis showed that B symptoms, gender, International Prognostic Index (IPI) score, disease stage and therapy were all independent prognostic factors.

CONCLUSIONS

The prognosis of extranodal NK/T-cell lymphoma, nasal type is poor and significantly influenced by B symptoms, gender, IPI score, clinical staging and the method of treatment. Chemoradiotherapy should be the first choice for treatment.

Successful granulocyte-colony stimulating factor treatment of Crohn's disease is associated with the appearance of circulating interleukin-10-producing T cells and increased lamina propria plasmacytoid dendritic cells

Granulocyte-colony stimulating factor (G-CSF) has proved to be a successful therapy for some patients with Crohn's disease. Given the known ability of G-CSF to exert anti-T helper 1 effects and to induce interleukin (IL)-10-secreting regulatory T cells, we studied whether clinical benefit from G-CSF therapy in active Crohn's disease was associated with decreased inflammatory cytokine production and/or increased regulatory responses. Crohn's patients were treated with G-CSF (5 microg/kg/day subcutaneously) for 4 weeks and changes in cell phenotype, cytokine production and dendritic cell subsets were measured in the peripheral blood and colonic mucosal biopsies using flow cytometry, enzyme-linked immunosorbent assay and immunocytochemistry. Crohn's patients who achieved a clinical response or remission based on the decrease in the Crohn's disease activity index differed from non-responding patients in several important ways: at the end of treatment, responding patients had significantly more CD4(+) memory T cells producing IL-10 in the peripheral blood; they also had a greatly enhanced CD123(+) plasmacytoid dendritic cell infiltration of the lamina propria. Interferon-gamma production capacity was not changed significantly except in non-responders, where it increased. These data show that clinical benefit from G-CSF treatment in Crohn's disease is accompanied by significant induction of IL-10 secreting T cells as well as increases in plasmacytoid dendritic cells in the lamina propria of the inflamed gut mucosa.

Correction of congenital severe ptosis by suspension of a frontal muscle flap overlapped with an inferiorly based orbital septum flap

BACKGROUND

This report introduces a new method for correction of congenital severe upper eyelid ptosis.

METHODS

The poor levator-function upper eyelid ptosis of 22 patients was corrected using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap as a motor unit, which substituted for the function of the levator muscle. The frontal muscle flap and orbital septum flap were formed in the frontal part and upper eyelid, respectively. Two flaps were overlapped and sutured to suspend the upper eyelid and to correct the congenital severe upper eyelid ptosis. This technique avoids the need for the linking structure necessary with the standard frontalis sling approach and improves the direction of pull to mimic that of a normal levator more closely than that of frontalis muscle advancement.

RESULTS

The follow-up period ranged from 6 to 20 months (mean, 12 months). A total of 4 patients had bilateral surgery, whereas 18 patients underwent unilateral surgery (26 eyelids). In 22 cases (26 eyes), congenital severe upper eyelid ptosis was treated using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap. After the operation, 17 cases (19 eyes) were followed up and analyzed retrospectively. The average follow-up period was about 12 months (range, 6-20 months). The 17 corrected eyes had a symmetric redundant fold of preseptal skin according to the marginal reflex distance-1 (MRD-1) measurement used to judge efficacy. Two eyes in this series required reoperation for undercorrection. Complications such as ectropion and corneal exposure were avoided.

CONCLUSION

Use of a frontalis muscle lap overlapped with an inferior based orbital septum flap to manage severe congenital upper eyelid ptosis is a useful procedure that results in substantial cosmetic and functional improvement with few complications.

Effects of recombinant human growth hormone on acute lung injury in endotoxemic rats

OBJECTIVE

To investigate the effects of recombinant human growth hormone (rhGH) on rat acute lung injury (ALI).

METHODS

ALI was mimicked by intraperitoneal (i. p.) injection of E. coli. Female Sprague-Dawley rats were randomized into three groups: control group, injected with physiologic saline (i. p.); ALI group, received a bolus injection of E. coli (1 x 10(10) cfu/l, 15 ml/kg, i. p.) followed by intramuscular physiologic saline injection; and ALI + GH group, received a bolus administration of E. coli, and then treated with intramuscular rhGH injection (2.25 U/kg/d). ALI group and ALI + GH group were subdivided into day 1 and day 3 subgroups, respectively. Left lungs were lavaged and bronchial alveolar lavage fluid (BALF) was harvested. Lung injury score, lung wet-to-dry weight (W/D) ratio, percentage of neutrophils (PMNs) in BALF, lung permeability index (LPI), intercellular adhesion molecule-1(ICAM-1) expression and activation of nuclear factor-kappa B (NF-kappaB) in the lungs were determined.

RESULTS

(1) On day 1 and day 3, the lung injury score, lung W/D ratio, LPI and protein content in BALF were significantly higher in the ALI group than in the control and ALI + GH groups. rhGH attenuated lung injuries significantly. (2) Compared with the control group, the percentage of PMNs in BALF was elevated significantly in the ALI and ALI + GH groups, especially in ALI group. (3) Nuclear positive rate of NF-kappaB and ICAM-1 expression at the levels of protein and mRNA in the lung in the ALI group on day 1 and day 3 were higher than in the control group. rhGH diminished activation of NF-kappaB and expression of ICAM-1 in the lung markedly.

CONCLUSIONS

Treatment with rhGH can significantly attenuate lung injury in the endotoxemic rats, which may be attributed to the reduction of the expression of ICAM-1, the influence on the adhesion and activation of PMNs, the inhibition of the activation of NF-kappaB and the regulation of the transcription of certain proinflammatory cytokines.

Beneficial effect of recombinant human growth hormone on the intestinal mucosa barrier of septic rats

The objective of the present study was to investigate the effects of recombinant human growth hormone (rhGH) on the intestinal mucosa barrier of septic rats and explore its possible mechanism. Female Sprague-Dawley rats were randomized into three groups: control, Escherichia coli-induced sepsis (S) and treatment (T) groups. Groups S and T were subdivided into subgroups 1d and 3d, respectively. Expression of liver insulin-like growth factor-1 (IGF-1) mRNA, Bcl-2 and Bax protein levels and the intestinal Bax/Bcl-2 ratio, and plasma GH and IGF-1 levels were determined. Histological examination of the intestine was performed and bacterial translocation was determined. rhGH significantly attenuated intestinal mucosal injuries and bacterial translocation in septic rats, markedly decreased Bax protein levels, inhibited the decrease of Bcl-2 protein expression and maintained the Bax/Bcl-2 ratio in the intestine. rhGH given after sepsis significantly improved levels of plasma GH (T1d: 1.28 +/- 0.24; T3d: 2.14 +/- 0.48 microg/L vs S1d: 0.74 +/- 0.12; S3d: 0.60 +/- 0.18 microg/L; P < 0.05) and IGF-1 (T1d: 168.94 +/- 65.67; T3d: 201.56 +/- 64.98 microg/L vs S1d: 116.72 +/- 13.96; S3d: 107.50 +/- 23.53 microg/L; P < 0.05) and expression of liver IGF-1 mRNA (T1d: 0.98 +/- 0.20; T3d: 1.76 +/- 0.17 vs S1d: 0.38 +/- 0.09; S3d: 0.46 +/- 0.10; P < 0.05). These findings indicate that treatment with rhGH had beneficial effects on the maintenance of the integrity of the intestinal mucosa barrier in septic rats.

Clinical significance and assessment of cytokines in various stages of ulcerative colitis

In order to study the clinical significance and change of interleukin (IL)-1 beta and IL-10 concentration in intestinal mucosal tissues in various stage of ulcerative colitis (UC), IL-1 beta and IL10 levels were measured by enzyme linked immunosorbent assays (ELISA). Our results showed that IL-beta level caused by spontaneous secretion in the intestinal mucous tissues in active stage of ulcerative colitis was significantly higher than that in normal controls and in remission stage of ulcerative colitis (P < 0.01, P < 0.001). IL-10 level in various stage of UC was relatively lower in controls, but there was no significantly difference between the two groups. Our study suggested that higher IL-1 beta level in active might play an important role in pathogenesis of UC, and IL-10, as an anti-inflammatory cytokine, was low in active UC, suggesting that it may be a important factor contributing to the development of higher IL-1 beta level.

Efficacy of hirudin in reducing cardiovascular events in patients with acute coronary syndrome undergoing early percutaneous coronary intervention

AIMS

Although hirudin is superior to unfractionated heparin for prevention of death, myocardial infarction, or refractory ischaemia in patients with non-ST-elevation acute coronary syndrome, it is not clear whether hirudin is also of benefit in acute coronary syndrome patients undergoing early percutaneous coronary intervention.

METHODS AND RESULTS

In the OASIS 2 trial, 10 141 patients with non-ST-elevation acute coronary syndrome were randomized to 72 h of intravenous hirudin or unfractionated heparin. Percutaneous coronary intervention was performed at the discretion of the investigator. One hundred and seventeen patients underwent percutaneous coronary intervention within the first 72 h ("early percutaneous coronary intervention"). In patients undergoing early percutaneous coronary intervention, hirudin compared with unfractionated heparin was associated with a significantly lower incidence of death or myocardial infarction at 96 h (6.4% vs 21.4%, OR 0.30; 95% CI: 0.10-0.88) and 35 days (6.4% vs 22.9%, OR 0.25; 95% CI: 0.07-0.86). In the unfractionated heparin group, death or myocardial infarction was significantly higher at 35 days in patients undergoing early percutaneous coronary intervention compared with those managed conservatively (22.9% vs 7.3%, OR 3.14, P<0.001) but this early percutaneous coronary intervention-related hazard was not observed in hirudin-treated patients (6.4% vs 6.8%, OR 0.94 P=1.0). A time-dependent covariate for percutaneous coronary intervention was not significant in a Cox regression model, suggesting a similar treatment benefit with hirudin before and after percutaneous coronary intervention. After adjustment for percutaneous coronary intervention propensity, the benefits of hirudin remained significant. There were three major bleeds in patients undergoing early percutaneous coronary intervention, all in patients randomized to hirudin.

CONCLUSION

In patients with non-ST-elevation acute coronary syndrome undergoing early percutaneous coronary intervention, a direct thrombin inhibitor such as hirudin may be more effective than heparin in reducing the incidence of ischaemic complications.

[A case report of idiopathic polypoidal choroidal vasculopathy]

PURPOSE

To report a case of idiopathic polypoidal choroidal vasculopathy (IPCV) and its angiographic characteristics.

METHODS

General ophthalmic check up, analyses of fundus picture, funds fluorescein angiography (FFA), indocyanine green angiography (ICGA) as well as literature review.

RESULTS

The lack of typical choroidal neovascularization (CNV) on FFA and characteristic polypoidal choroidal vasculopathy on ICGA as well as its unsymmetrical manifestation and discrepancy with age-related macular degeneratio (AMD) on the fundus picture are typical signs for the diagnosis of IPCV.

CONCLUSION

The angiographic features on FFA and ICGA are specific for the diagnosis of IPCV. Differentiating IPCV and AMD has clinical significance in prognosing the visual acuity, progress and management of the diseases.

[Correlations of Ki-67 expression and histopathologic characteristics in uveal melanomas]

PURPOSE

To investigate the relations between the cellular proliferation and histopathologic variables in paraffin embedded uveal melanomas with the using of the monoclonal antibody Ki-67 as a proliferation marker.

METHODS

Fifty-seven enucleated eyes were included for histopathological study and Ki-67 immunostaining. All these eye globes were enucleated between 1988 and 1997 without prior treatment.

RESULTS

The score of Ki-67 index ranged from zero to 4.89%, mean (0.75 +/- 1.02) %. The mean score of Ki-67 was significantly higher in large tumors (P = 0.007) or in tumors that contained epithelioid cells (P = 0.037) when compared to medium size tumors or to spindle cell type tumors. There was a significant difference of the distribution of epithelioid cell and spindle cell when compared histologic cell type with tumor size (chi 2 = 4.528, P < 0.05). Higher proportions of large tumors were found in epithelioid cell group. No significant correlation was found between the Ki-67 index and tumor location, scleral extension and age.

CONCLUSION

The Ki-67 index is significantly correlated with the histologic cell type and tumor size.

Analysis of mono- and oligosaccharides by multiwavelength surface plasmon resonance (SPR) spectroscopy

Surface plasmon resonance (SPR) spectra of different saccharides were collected using a home-made multiwavelength SPR apparatus. Pentoses, hexoses, disaccharides and a trisaccharide were distinguished from one another according to their SPR spectra collected at the same concentration. The spectra were also used for the quantitation of sugars by exploring the linear relationship between resonance wavelength and solute concentration. The dynamic linear ranges for the determination of glucose, sucrose and raffinose are 0.01-0.2, 0.005-0.1 and 0.0025-0.1 mol/L, respectively. The SPR spectrum of a mixture of two components was investigated. While the experiments have not been carried out, the implications from this work are that the technique would be applicable to mixtures containing more than two components.

Clinical analysis of Leber's hereditary optic neuropathy harboring mtDNA mutation at nt11778

PURPOSE

To improve our diagnostic technique through the analysis of clinical features of Leber's hereditary optic neuropathy (LHON) harboring mtDNA point mutation at nt11778.

METHODS

Detection of nt11778 mutation was performed on 38 patients clinically diagnosed as LHON in our ophthalmic center from year 1998 to 2000. Circumstances of onset and family history were obtained and ophthalmoscopy, fundus fluorescein angiography, visual field and visual evoked potential were performed on all 38 patients.

RESULT

30 In 38 patients (78.95%) harbor nt11778 mutation, including 28 male (93.33%) and 2 female (6.67%). The ratio of affected male to female is 14:1. Patients harboring nt11778 mutation display typical clinical manifestations.

CONCLUSION

Identification of one of the three LHON specifically associated mtDNA mutations is essential to confirm the diagnosis.

Change of visual acuity and related factors in idiopathic optic neuritis

PURPOSE

To study the change of visual acuity and related factors in idiopathic optic neuritis.

METHODS

Retrospectively studying 136 cases (210 eyes) of idiopathic optic neuritis hospitalized in our department during last 5 years. The data was analyzed with the methods of multivariate stepwise regression analysis by SPSS statistic package.

RESULTS

The final visual acuity was very strongly related positively to the initial visual acuity at the time point of starting treatment and negatively to the time span beginning the treatment to the time showing improvement, age of patient and the duration from onset of the disorder to the time point of treatment beginning.

CONCLUSIONS

Promptly right treatment can significantly change the natural course and the final vision of optic neuritis. Severe visual loss, old age, longer time without right therapy and slow improvement after the treatment may indicate an unfavorable final visual recovery. The different dosages of steroid applied in this study was not significant in view of the final visual acuity.

Prognostic significance of thrombocytopenia during hirudin and heparin therapy in acute coronary syndrome without ST elevation: Organization to Assess Strategies for Ischemic Syndromes (OASIS-2)study

BACKGROUND

The development of thrombocytopenia in acute coronary syndromes (ACS) appears to be associated with adverse clinical outcomes. Unfractionated heparin is a recognized cause of thrombocytopenia, but the incidence, predictors, and prognostic significance of thrombocytopenia during hirudin therapy in ACS have not been reported.

METHODS AND RESULTS

Patients with ACS without ST elevation were randomized in a double-blind manner to receive a 72-hour intravenous infusion of unfractionated heparin or hirudin. Platelet counts were measured at baseline and within 24 hours of completion of study drug. The overall incidence of thrombocytopenia (<100x10(9)/L) was 1% and was similar in unfractionated heparin- and hirudin-treated patients (P:=0.42). Thrombocytopenia during study drug infusion was an independent predictor of 7-day outcomes, including death (OR, 6.7; 95% CI, 1.9 to 25); the composite of death, myocardial infarction, and recurrent ischemia (OR, 2.0; 95% CI, 1.0 to 1.5); revascularization (OR, 4.0; 95% CI, 2.2 to 7.1); and major bleeding (OR, 8.3; 95% CI, 3.4 to 17.7). Among patients who developed thrombocytopenia, hirudin (OR, 5.4; 95% CI, 2.6 to 11.3) but not unfractionated heparin (OR, 2.0; 95% CI, 0.3 to 14.4) therapy was associated with a significantly increased risk of major bleeding.

CONCLUSIONS

Early-onset thrombocytopenia in patients with ACS without ST elevation is strongly associated with adverse clinical outcomes, including death, ischemic events, and bleeding. The excess of major bleeding in hirudin-treated patients who develop thrombocytopenia suggests that thrombocytopenia may contribute to the increased risk of bleeding observed with hirudin.

Osteogenic potential of cultured bone marrow stromal cells transfected with transforming growth factor beta 1 gene in vitro

To study the osteogenic potential of cultured bone marrow stromal cells (BMSCs) transfected with transforming growth factor beta 1 (TGF-beta 1) gene in vitro, cultured BMSCs were transfected with the complexes of pcDNA3-TGF-beta 1 and Lipofectamine Reagent in vitro. The cell proliferation was detected by MTT method and the morphological features of transfected BMSCs was observed. ALP stains and PNP method were used to measure ALP activity. In addition, the collagen type I propeptides and mineralized matrixes were examined by immunohistochemical staining and tetracycline fluorescence labeling respectively. The morphological and biological characters of the transfected BMSCs were similar to those of osteoblasts and the cell proliferation was promoted. The cell layer displayed strong positive reaction for ALP stains and immunohistochemical staining. ALP activity and collagen type I expression increased remarkably after transfection. Mineralized matrixes formed earlier and more in transfected BMSCs as compared with control group. It is concluded that transfecting with TGF-beta 1 gene could promote the osteogenic potential of cultured BMSCs.

Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction

OBJECTIVES

We sought to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior myocardial infarction (MI).

BACKGROUND

There is uncertainty regarding the risk of major complications in patients with inferior MI complicated by RV myocardial involvement. Whether these complications are related to RV myocardial involvement itself or simply to the extent of infarction involving the left ventricle (LV) is also unknown.

METHODS

We examined the incidence of death and mechanical and electrical complications in patients with (n = 491) and without (n = 638) RV myocardial involvement and in patients with anterior MI (n = 971) in an analysis from the Collaborative Organization for RheothRx Evaluation (CORE) trial. Left ventricular infarct size was assessed by technetium-99m-sestamibi single-photon emission computed tomography and peak creatine kinase, and LV function was assessed by radionuclide angiography. We also performed a meta-analysis in which we pooled the results of our study with previous smaller studies addressing the same question.

RESULTS

Six-month mortality was 7.8% in inferior MI compared with 13.2% in anterior MI. Among patients with inferior MI, serious arrhythmias were significantly more common in patients with RV myocardial involvement who also had a trend toward higher mortality, pump failure and mechanical complications. However, this was not associated with a difference in LV infarct size or function. A meta-analysis of six studies (n = 1,198) confirmed that RV myocardial involvement was associated with an increased risk of death (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.4 to 4.1), shock (OR 3.2, 95% CI 2.4 to 3.5), ventricular tachycardia or fibrillation (OR 2.7, 95% CI 2.1 to 3.5) and atrioventricular block (OR 3.4, 95% CI 2.7 to 4.2).

CONCLUSIONS

Patients with inferior MI who also have RV myocardial involvement are at increased risk of death, shock and arrhythmias. This increased risk is related to the presence of RV myocardial involvement itself rather than the extent of LV myocardial damage.

[Surgical treatment of recurrent dislocation of the patella in children]

OBJECTIVE

To study an operative method for repair of recurrent dislocation of the patella in children.

METHODS

36 children with recurrent patellar dislocation were treated surgically at an average age of 9.1 years. They were followed on average for 4 years and 4 months. Nine of the 36 children underwent bilateral repair, with 45 knees were treated. The combined soft tissue operations included lateral retinacular releasing, medial retinacular tightening of the knee, vastus medialis muscle transfer to the patella, medial and distal transfer of the half patellar tendon.

RESULTS

28 patients had stable knee joint and a full range of motion, and improved sports activity after operation. Seven children achieved satisfactory function of the knee joint but there was no significant difference between pre-and postoperative sports exercise ability. One child suffered from a redislocation of the patella. Wound infection was not seen and the range of knee joint motion was not restricted in all patients.

CONCLUSIONS

The combined procedures for repair of recurrent dislocation of the patella in children risk free for growth disturbances secondary to iatrogenic injury to the proximal tibial physis. It is safe and effective for recurrent dislocation of the patella in skeletally immature children.

Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE)

Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese and Europeans. A total of 985 participants were recruited from three cities (Hamilton, Toronto and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5% and 2%, respectively; p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm) and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and low-density lipoprotein cholesterol, higher triglycerides and lower high-density lipoprotein cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein(a), and plasminogen activator inhibitor-1. Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.