Red blood cell distribution width is associated with incidence of atrial fibrillation

OBJECTIVES

Red blood cell distribution width (RDW), a measure of variation in erythrocyte volume, has been associated with several cardiovascular disorders, but the relationship with atrial fibrillation (AF) remains unclear. We investigated the association between RDW and incidence of first hospitalization due to AF in a population-based cohort.

DESIGN

Red blood cell distribution width was measured in 27,124 subjects from the general population (age 45-73 years, 62% women) with no history of AF, heart failure, myocardial infarction or stroke. The association between baseline RDW and incidence of AF identified from the Swedish Hospital Discharge Register was evaluated.

RESULTS

During a mean follow-up of 13.6 years, 1894 subjects (53% men) were hospitalized with a diagnosis of AF. After adjustment for potential confounding factors, including cardiovascular disease risk factors, nutrient intake (iron, vitamin B12 and folate) and several haematological parameters (haemoglobin concentration, mean corpuscular volume and corpuscular haemoglobin content), the hazard ratio (HR) for incidence of AF was 1.33 [95% confidence interval (CI) 1.16-1.53] for the fourth versus first quartile of RDW (P for trend <0.001). The results were essentially unchanged when subjects with incident myocardial infarction or hospitalizations because of heart failure were censored from the analysis (HR 1.30, 95% CI 1.13-1.51; P for trend = 0.001).

CONCLUSION

Red blood cell distribution width was associated with incidence of AF independently of several cardiovascular, nutritional and haematological factors in this study of middle-aged subjects from the general population.

High levels of cystatin C predict the metabolic syndrome: the prospective Malmö Diet and Cancer Study

OBJECTIVE

Cystatin C is a novel marker of cardiovascular disease (CVD); however, the underlying mechanisms remain unclear. Here, we prospectively investigated whether plasma levels of cystatin C predict new-onset metabolic syndrome (MetS) as well as long-term progression and incidence of the different components of the MetS.

METHODS

Cystatin C was measured in 1502 individuals included in the Malmö Diet and Cancer cardiovascular cohort (mean age 56 years, 59% women) who were free from the MetS at baseline and subsequently underwent a follow-up examination after a median of 16 years. MetS was defined according to the NCEP-ATP-III guidelines. Logistic regression was used to adjust for covariates.

MAIN OUTCOME MEASURES

Metabolic syndrome and long-term progression as well as incidence of the different components of the MetS.

RESULTS

During follow-up, 428 subjects developed new-onset MetS. In age- and sex-adjusted analysis, compared with the lowest quartile of cystatin C, the odds ratios (95% confidence interval) for incident MetS in subjects with cystatin C levels in quartiles 2, 3 and 4 were 1.00 (0.71-1.40), 1.48 (1.06-2.07) and 1.91 (1.37-2.68), respectively (Ptrend  < 0.001); this linear association remained significant even after full multivariate adjustment (Ptrend  = 0.041). Interestingly, in this fully adjusted model, long-term progression of abdominal obesity was the only component of the MetS significantly associated with increasing quartiles of baseline cystatin C levels (Ptrend  = 0.008).

CONCLUSION

These findings suggest that cystatin C may adversely affect metabolic factors, particularly abdominal obesity, thus contributing to development of the MetS. Our results may help to explain the link between cystatin C and development of CVD.

The clinical significance of Nicoletella semolina in horses with respiratory disorders and a screening of the bacterial flora in the airways of horses

Nicoletella semolina, a member of the family Pasteurellaceae, can be isolated from the airways of horses with respiratory disorders. However, its role as a potential or opportunistic pathogen is not clear nor is its presence as part of the normal flora. We therefore investigated the presence and bacterial load of N. semolina in healthy and diseased horses. Samples from a healthy control group were compared with samples from the routine analysis of horses with a clinical history of respiratory disorders. A total of 1770 nose swabs and 1132 tracheal aspirate samples were analysed and subjected to conventional bacteriological examination. N. semolina was isolated from 12 (6%) of 207 nose samples from the healthy control group and from 42 (3%) of 1563 samples from horses with respiratory disorders. In tracheal aspirate, N. semolina was isolated from 7 (3%) of 211 samples from the control group and 49 (5%) of 921 samples from horses with respiratory disorders. Other bacteria were also isolated in laboratory analyses, the most commonly isolated bacterium in both the control group and the respiratory disorders group being Streptococcus equi subsp. zooepidemicus. It was isolated in 21% of tracheal aspirate from the control group and 33% of those from horses with respiratory disorders. In conclusion, N. semolina is not a primary pathogenic bacterium, as it was isolated at similar frequencies in horses with respiratory disorders and those in the healthy control group.

An evaluation of current services available for people diagnosed with head and neck cancer in the UK (2009-2010)

AIMS

To evaluate current care and service provision for people with head and neck cancer in the UK.

MATERIALS AND METHODS

Self-report questionnaires for cancer networks, clinical leads of oncology units and leads for multidisciplinary teams (MDTs) were designed. These questionnaires were based on a previous survey. Questionnaires were sent out between 2009 and 2010.

RESULTS

Questionnaires were received from all networks (n = 37), most oncology units (48 of 53) and most MDTs (51 of 63). Care for people with head and neck cancer is increasingly being provided by a centralised MDT. The membership of these teams varies; facilities available for team meetings are fit for purpose in most cases. MDTs are meeting frequently (weekly meetings in 96%) and discussing on average 18 cases at each meeting (95% confidence interval 15-21 cases). Most oncologists have access to all common anti-cancer drugs and most have access to all forms of radiotherapy. Intensity-modulated radiotherapy is not yet available in some oncology units (28%). A small number of units have only one oncologist (13%). Despite audit and research being part of the rationale for MDT working, regular discussion of morbidity and mortality is unusual (40%) and use of a database to record decisions is not universal. Only seven centres record decisions into the Data for Head and Neck Oncology database. Reported recruitment to studies is generally low (<2% of cases enrolled in studies in 62%).

CONCLUSIONS

Head and neck cancer care is increasingly provided through a centralised MDT. Increased resources and further changes in practice are required to implement current National Health Service cancer policy. Teams need to improve recording of their decision-making, discuss morbidity and mortality and support recruitment to clinical studies.

Copeptin, a marker of vasopressin, in abdominal obesity, diabetes and microalbuminuria: the prospective Malmö Diet and Cancer Study cardiovascular cohort

BACKGROUND

High plasma copeptin (copeptin), the C-terminal fragment of arginine vasopressin pro-hormone, has been associated with the metabolic syndrome (MetS), diabetes mellitus (DM) development and nephropathy. Here we tested whether elevated copeptin level is associated with later development of the MetS, its individual components and microalbuminuria.

METHODS

We analysed copeptin at baseline (1991-1994) in the population-based Malmö Diet and Cancer Study cardiovasular cohort and re-examined 2064 subjects 15.8 years later (mean age 72.8 years, 59% women) with oral glucose tolerance test and measurement of MetS and its individual components.

RESULTS

After age and sex adjustment, increasing quartiles of copeptin at baseline (the lowest quartile as reference) were associated with MetS (P for trend=0.008), incident abdominal obesity (P for trend=0.002), DM (P for trend=0.001) and microalbuminuria (P for trend=0.002). After additional adjustment for all the MetS components at baseline, increasing copeptin quartiles predicted incident abdominal obesity (odds ratios 1.55, 1.30 and 1.59; P for trend=0.04), DM (odds ratios 1.18, 1.32 and 1.46; P for trend=0.04) and microalbuminuria (odds ratios 1.05, 1.08 and 1.65; P for trend=0.02) but not MetS (P for trend=0.19) at the reexamination. Further, the relationship between copeptin and microalbuminuria was independent of baseline C-reactive protein, incident DM and incident hypertension.

CONCLUSION

Copeptin independently predicts DM and abdominal obesity but not the cluster of MetS. Apart from predicting DM and abdominal obesity, elevated copeptin signals increased risk of microalbuminuria. Interestingly, the association between copeptin and later microalbuminuria was independent of both prevalent and incident DM and hypertension. Our findings suggest a relationship between a dysregulated vasopressin system and cardiometabolic risk, which could have implications for risk assessment and novel preventive treatments.

Rational targeting of the urokinase receptor (uPAR): development of antagonists and non-invasive imaging probes

In the last two decades, the urokinase-type plasminogen activator receptor (uPAR) has been implicated in a number of human pathologies such as cancer, bacterial infections, and paroxysmal nocturnal hemoglobinuria. The primary function of this glycolipid-anchored receptor is to focalize uPA-mediated plasminogen activation at the cell surface, which is accomplished by its high-affinity interaction with the growth factor-like domain of uPA. Detailed insights into the molecular basis underlying the interactions between uPAR and its two bona fide ligands, uPA and vitronectin, have been obtained recently by X-ray crystallography and surface plasmon resonance studies. Importantly, these structural studies also define possible druggable target sites in uPAR for small molecules and provide guidelines for the development of reporter groups applicable for non-invasive molecular imaging of uPAR expression in vivo by positron emission tomography. In this review, we will discuss recent advances in our perception of the structure-function relationships of uPAR ligation and how these may assist translational research in preclinical intervention studies of uPAR function.

Disproportionate body composition and perinatal outcome in large-for-gestational-age infants to mothers with type 1 diabetes

OBJECTIVE

To determine if disproportionate body composition is a risk factor for perinatal complications in large-for-gestational-age infants born to mothers with type 1 diabetes.

DESIGN

Population-based cohort study.

SETTING

Data from the Swedish Medical Birth Registry from 1998 to 2007.

POPULATION

National cohort of 3517 infants born to mothers with type 1 diabetes. Only singletons with gestational age 32-43 weeks were included.

METHODS

Large for gestational age (LGA) was defined as birthweight > 90th centile and appropriate for gestational age (AGA) as birthweight between 10th and 90th centiles. Disproportionate (D) infants were defined as having a ponderal index [PI: calculated as birthweight in grams/(length in cm)(3) > 90th centile] and proportionate (P) as PI ≤ 90th centile. LGA infants were classified as P-LGA or D-LGA. Odds ratios were calculated for D-LGA and P-LGA infants, with AGA infants as the reference category. Odds ratios were adjusted for mode of delivery, fetal distress and stratified by gestational age.

MAIN OUTCOME MEASURES

The primary outcome was a composite of neonatal morbidities, i.e. any of the following diagnoses: Apgar score < 7 at 5 minutes, birth trauma (Erb's palsy or clavicle fracture), respiratory disorder, hyperbilirubinaemia or hypoglycaemia requiring treatment.

RESULTS

Composite morbidity was significantly more frequent in LGA as opposed to AGA infants, but there was no difference in risk between P-LGA and D-LGA infants.

CONCLUSIONS

High birthweight, irrespective of body proportionality, is a risk factor for neonatal complications in offspring of women with type 1 diabetes.

A single-step competitive binding assay for mapping of single DNA molecules

Optical mapping of genomic DNA is of relevance for a plethora of applications such as scaffolding for sequencing and detection of structural variations as well as identification of pathogens like bacteria and viruses. For future clinical applications it is desirable to have a fast and robust mapping method based on as few steps as possible. We here demonstrate a single-step method to obtain a DNA barcode that is directly visualized using nanofluidic devices and fluorescence microscopy. Using a mixture of YOYO-1, a bright DNA dye, and netropsin, a natural antibiotic with very high AT specificity, we obtain a DNA map with a fluorescence intensity profile along the DNA that reflects the underlying sequence. The netropsin binds to AT-tetrads and blocks these binding sites from YOYO-1 binding which results in lower fluorescence intensity from AT-rich regions of the DNA. We thus obtain a DNA barcode that is dark in AT-rich regions and bright in GC-rich regions with kilobasepair resolution. We demonstrate the versatility of the method by obtaining a barcode on DNA from the phage T4 that captures its circular permutation and agrees well with its known sequence.

Food patterns, inflammation markers and incidence of cardiovascular disease: the Malmö Diet and Cancer study

OBJECTIVES

To examine the associations between food patterns constructed using cluster analysis and markers of systemic and vascular inflammation, and incident cardiovascular disease (CVD) after 13 years of follow-up.

DESIGN

Population-based, prospective cohort study.

SETTING AND SUBJECTS

Cluster analysis identified six food patterns from 43 food group variables among 4999 subjects, aged 45-68 years, who participated in the Malmö Diet and Cancer cardiovascular programme between 1991 and 1994. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2) ), C-reactive protein concentration and white blood cell (WBC) count were measured using blood samples at baseline. Incidence of CVD (coronary events and ischaemic stroke) was monitored over 13 years of follow-up.

RESULTS

The fibre-rich bread pattern was associated with favourable effects on WBC count in women, and the low-fat and high-fibre pattern with favourable effects on Lp-PLA(2) mass in women, and on Lp-PLA(2) activity in men. However, the milk fat and sweets and cakes patterns were both associated with adverse effects; the former on WBC count in women and on Lp-PLA(2) mass in men, and the latter on WBC count and Lp-PLA(2) mass in women. The milk fat and sweets and cakes patterns were associated with increased CVD risk in women.

CONCLUSIONS

The results of this study support the present Nordic dietary recommendations indicating that diets rich in high-fibre, low-fat and low-sugar foods are favourably associated with markers of inflammation and, potentially, with CVD risk.

Why are multi-centre clinical observational studies still so difficult to run?

Despite the introduction of IRAS, obtaining R&D approvals for multicentre studies is a major rate limiting step. Our experience with cleft research demonstrates that this approvals process must be drastically and rapidly improved if we wish to continue attract clinical research to the UK.

Why sliding friction of Ne and Kr monolayers is so different on the Pb(111) surface

To understand the tribological properties of Ne and Kr on Pb(111), the potential energy surfaces for sliding motion of Ne, Kr, and Xe monolayers on the Pb(111) surface are examined through density functional calculations, using either local density or self-consistent nonlocal van der Waals functionals. The calculated adsorption energy for Xe/Pb(111) agrees well with experiment, validating the present approach and parameters. Activation energies along a sliding path indicate that Ne motion is much faster than Kr and Xe on Pb(111) at T∼6  K, which explains the puzzling experimental observation.

Disease patterns and immune responses in the offspring to sows with high or low antibody levels to Actinobacillus pleuropneumoniae serotype 2

The serum antibody responses to Actinobacillus pleuropneumoniae and the secondary invader Pasteurella multocida were monitored from birth until slaughter in the offspring to sows with high or low levels of serum antibodies to A. pleuropneumoniae. Serum antibody concentrations to A. pleuropneumoniae were higher from birth to the age of 9 weeks in piglets delivered by high responding sows. In contrast, antibody levels to P. multocida were similar in both groups during this period. From the age of 20 and 15 weeks, antibody levels to A. pleuropneumoniae and P. multocida, respectively, were higher in the offspring to high responding sows. This implies that the offspring to sows with high levels of antibodies may be better protected during the first period of life because of a higher level of passively derived immunity. These piglets will also mount a higher antibody response when later infected, indicating a heritability of the humoral immune response.

Diversity of spore-forming bacteria in cattle manure, slaughterhouse waste and samples from biogas plants

AIMS

As biowaste intended for biogas production can contain pathogenic micro-organisms, the recommended treatment is pasteurization at 70°C for 60min. This reduces pathogens such as Salmonella spp., whereas spore-forming bacteria (Bacillus spp. and Clostridium spp.) survive. Most spore-forming bacteria are harmless, but some can cause diseases such as blackleg, botulism and anthrax. In this study, the effect of the biogas process on Bacillus spp. and Clostridium spp. was investigated.

METHODS AND RESULTS

We analysed 97 faecal samples, 20 slaughterhouse waste samples and 60 samples collected at different stages in the biogas process. Bacillus spp. and Clostridium spp. were quantified and subcultured. The isolates were identified by biochemical methods and by 16S rRNA gene sequencing. Phylogenetic trees were constructed from the sequences obtained from isolates from the samples. Clostridium botulinum/Clostridium spp. and Clostridium sordellii were found both before and after pasteurization, but not after digestion (AD). Some of the isolated strains probably represented new members of the genera Clostridium and Bacillus.

CONCLUSION

After digestion, the numbers of clostridia decreased, but none of the pathogenic bacteria did, whereas Bacillus spp. remained constant during the process.

SIGNIFICANCE AND IMPACT OF THE STUDY

Biogas is gaining in importance as an energy source and because the residues are used as fertilizers, we needed to study the prevalence of pathogenic bacteria in such material.