Comparison of the values of basic fibroblast growth factor determined by an immunoassay in the sera of patients with traumatic brain injury and enhanced osteogenesis and the effects of the same sera on the fibroblast growth in vitro

In patients with severe traumatic brain injury, the early healing of fractures is accompanied by hypertrophic callus formation or heterotopic ossifications, which might even result in ankylosis of the affected joints. Analysis of the sera of patients with traumatic brain injury revealed post-traumatic dynamic changes of basic fibroblast growth factor immunoreactivity, similar to those observed during fracture healing associated with enhanced osteogenesis. The aim of this study was to determine whether such changes in basic fibroblast growth factor concentrations could be related to the phenomenon of enhanced osteogenesis. Basic fibroblast growth factor immunoreactivity was determined (using an IEMA kit) in the sera of patients with traumatic brain injury and bone fractures (n = 8) and in the sera of patients with either traumatic brain injury alone (n = 10) or bone fractures alone (n = 7), and the effects of these sera on L929 fibroblast growth were analysed in vitro. The results did not prove a causative relationship between the changes of basic fibroblast growth factor immunoreactivity and in vitro growth promoting effects of the sera. However, it is apparent that, in addition to changes in the growth-promoting activity and basic fibroblast growth factor concentration of serum, other as yet unknown post-traumatic changes can cause enhanced osteogenesis.

Lipoprotein(a) and asymptomatic carotid artery disease. Evidence of a prominent role in the evolution of advanced carotid plaques: the Bruneck Study

BACKGROUND AND PURPOSE

Elevated levels of lipoprotein(a) [Lp(a)] have been reported in association with symptomatic coronary and carotid artery disease. Relevancy of Lp(a) as a risk predictor of presymptomatic atherosclerosis in general populations is not well established.

METHODS

Serum Lp(a) distribution and its relation to sonographically assessed carotid atherosclerosis were examined in a random sample of 885 men and women aged 40 to 79 years (Bruneck Study).

RESULTS

Logistic regression analysis revealed a binary-type association between Lp(a) and carotid artery disease, with the threshold level of Lp(a) for an enhanced atherosclerosis risk defined at 32 mg/dL. The strength of relation increased with advancing severity of carotid atherosclerosis (odds ratios for Lp(a), 1.8 for nonstenotic and 4.7 for stenotic carotid artery disease; P < .001). Lp(a) was unaffected by environmental factors except for a significant decrease in women taking hormone replacement therapy (P < .05). In a multivariate approach, Lp(a) turned out to be an independently significant predictor of carotid atherosclerosis (P < .001). No differential effect of Lp(a) on atherosclerosis (effect modification) was observed for sex, age, low-density lipoprotein cholesterol, apolipoprotein A-I and B, fasting glucose, diabetes, or hypertension. However, the Lp(a)-atherosclerosis relation was significantly modified by fibrinogen (P < .01) and antithrombin III (P < .05).

CONCLUSIONS

The present study demonstrates a strong and independent association between elevated Lp(a) levels and carotid atherosclerosis in a large randomized population and provides evidence of a potential role of Lp(a) in the evolution of carotid stenosis. Apart from atherogenicity of Lp(a) cholesterol, interference with fibrinolysis of atheroma-associated clots and fibrin deposits in the arterial wall may achieve pathophysiological significance.

Basic fibroblast growth factor (BFGF) immunoreactivity as a possible link between head injury and impaired bone fracture healing

Healing of fractures of long bones or large joints is often accelerated in patients with severe traumatic brain injury (TBI). However, in these patients an early fracture healing is accompanied by hypertrophic callus formation or heterotopic ossifications which might even result in an ankylosis of the affected joints. It seems that enhanced osteogenesis in patients suffering from TBI could be caused by some humoral factors, since the sera of these patients strongly promote the growth of osteoblast cells in vitro. However, humoral growth promoting factors which could perhaps induce enhanced osteogenesis are not yet identified. Hence, the aim of this study was to analyse if basic fibroblast growth factor (bFGF) could be related to the phenomenon of enhanced osteogenesis, since bFGF stimulates the growth of osteoblasts in vitro and could be found both in the brain and the bone tissue. For that purpose the values of bFGF immunoreactivity were determined in the sera of patients with TBI and bone fractures (n = 8) as well as in the sera of patients with either TBI alone (n = 10) or bone fractures alone (n = 7), during a period of three months after injury. Quantification of the bFGF immunoreactivity was done using the ELISA based on monoclonal antibodies raised against the recombinant human bFGF. The bFGF immunoreactivity values obtained were also compared with the values determined in the sera of normal, healthy persons (n = 9). In the group of patients with bone fractures alone only a transient increase of bFGF immunoreactivity (threefold above the normal values) was observed in the second week after injury. A similar increase of the values of bFGF immunoreactivity was also determined in the sera of patients with TBI only, but it lasted longer (from the 1st until the 7th to 8th week after injury). In the case of patients with TBI and bone fractures a specific pattern of post-traumatic dynamic change of the values of serum bFGF immunoreactivity was observed. Namely, the increase of bFGF immunoreactivity (up to seven-fold above the normal values) was determined even during the first week after injury. Afterwards, periods of high values of bFGF immunoreactivity observed during the 2nd, 4th and the 7-10th weeks after injury were interrupted by sudden decreases even to the normal values (during the 3rd and the 5-6th week after injury).(ABSTRACT TRUNCATED AT 400 WORDS)

Body iron stores and presence of carotid atherosclerosis. Results from the Bruneck Study

We hypothesized that the formation of foam cells and fatty streaks requires a postsecretory oxidative modification of lipoproteins that targets them for rapid uptake by macrophages. Lipid peroxidation may in part depend on the concentration of tissue iron, one of the major oxidants in vivo. We analyzed the relation between sonographically assessed carotid atherosclerosis and body iron stores in a population sample of 847 men and women aged 40 to 79 years. In a logistic regression analysis adjusting for age, sex, and all major vascular risk markers, ferritin emerged as one of the strongest indicators of carotid artery disease in both sexes (40 to 59 years; odds ratio, 1.54 per 100 micrograms/L; P < .001). The predictive significance of ferritin was found to be synergistic with that of hypercholesterolemia. Variations in body iron stores between sexes may partly explain evident sex differences in the expression of carotid atherosclerosis. In the elderly (> or = 60 years) the predictive significance of ferritin was found to decrease parallel to that of apolipoprotein B. The current study suggests a possible role of body iron in early atherogenesis.

Alcohol consumption and carotid atherosclerosis: evidence of dose-dependent atherogenic and antiatherogenic effects. Results from the Bruneck Study

BACKGROUND AND PURPOSE

Although a variety of epidemiological studies have suggested a U-shaped association between alcohol and cardiovascular disease, controversy still surrounds the role of atherogenesis in the mediation of alcohol effects.

METHODS

Carotid atherosclerosis was measured with a sensitive and reproducible B-mode score in a random sample of 460 men drawn from the Bruneck Study (baseline examination in 1990).

RESULTS

The age-adjusted relation between alcohol and carotid artery disease was U shaped, with light drinkers facing a lower atherosclerosis risk (odds ratio, 0.44; 95% confidence interval, 0.23 to 0.85; P = .01) than either abstainers (odds ratio, 1.00) or heavy drinkers (odds ratio, 2.78; 95% confidence interval, 1.32 to 5.84; P < .01). The association was not explained by the lifestyle of alcohol consumers (smoking) or inclusion of former (heavy) drinkers in the reference group. The effect of alcohol was modified by drinking behavior (type of beverage). Approximately a quarter of the atherosclerosis risk caused by severe alcohol consumption was mediated by the risk profile associated with drinking, whereas the apparent beneficial effect of low alcohol intake emerged independent of conventional risk attributes.

CONCLUSIONS

Our results support the hypothesis that adverse and beneficial effects of alcohol on cerebrovascular disease are mediated in part by analogous atherogenic and antiatherogenic properties.

Migratory activity of blood polymorphonuclear leukocytes during juvenile rheumatoid arthritis, demonstrated with a new whole-blood membrane filter assay

Polymorphonuclear leukocyte (PMN) migration is measured in whole blood in a migration chamber consisting of a membrane filter (3-microns pores, 140 microns thick) with an integrated chemoattractant depot (FMLP in solid form) attached to a plastic container. Control chambers lack FMLP (blanks). One test unit requires 300 microliters blood. Numbers and distribution of the PMN immigrants into the filters are determined microscopically. Altogether 26 measurements of PMN migration in five juvenile rheumatoid arthritis (JRA) patients with varying disease activity were compared with the reactions of a healthy control group (N = 32). Correlations were calculated with conventional laboratory parameters (WBC, PLT, BSR, CRP, Hgb, serum Fe) and disease activity. In comparison with healthy controls, PMNs of JRA patients generally show a markedly increased penetration depth into the filters irrespective the presence of the chemoattractant or the disease activity. Increased migratory reactions to FMLP in comparison to blanks were found during high disease activity only. The PMN penetration depth correlates positively with the CRP, and reciprocally with the Hgb blood levels. The migration assay combines fast and simple processing with good preservation of the genuine PMN activation state.

The lipid peroxidation product 4-hydroxynonenal is formed by--and is able to attract--rat neutrophils in vivo

4-Hydroxynonenal (HNE), a major aldehydic product of lipid peroxidation, is a chemoattractant for neutrophilic polymorphonuclear granulocytes in vitro. The question was studied, whether HNE is formed during the ingress of neutrophils in the Sephadex model of inflammation. The polydextrane Sephadex G-200, which causes an acute aseptic traumatic inflammation, was injected subcutaneously into rats. The implants were excised 6-36 hours later, and the neutrophils separated from the exsudate by centrifugation. After extraction with dichloromethane HNE was identified in the exsudate by non-derivative reversed phase HPLC in combination with on-line uv-spectroscopy. The concentration of HNE in the inflammatory focus did not correlate with the number of neutrophils present. While the peak of HNE coincided with the time point of the highest turnover rate of neutrophils (0.13 microM at 6 hrs after implantation), the highest number of neutrophils (about 100 million cells) occurred not earlier than 18 hrs later (24 hrs after onset of inflammation). When neutrophils were isolated from the inflammatory focus and stimulated with Zymosan, they were able to produce HNE in vitro depending on the time of isolation. The highest production of HNE (0.17 microM) by phagocyting neutrophils was observed at the shortest inflammation time studied (3 hrs). In order to compare these results with the oxidative burst of neutrophils the formation of superoxide was also measured by the cytochrome c reduction assay in vitro. The maximum of the production rate of superoxide anion was observed at the same inflammation time (6 hrs), when the HNE maximum occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Polymorphonuclear leucocyte migration response in uneventful wound healing following trauma surgery. A contribution to the search for objectifiable criteria in wound healing monitoring

In a study of the clinical importance of polymorphonuclear granulocytes (PMN) for the monitoring of wound healing we investigated the postsurgical course of nine patients all of whom had undergone trauma surgery and had no wound complications. The "stimulated random PMN locomotion" was evaluated by a new migration filter device which preserves the cells in their genuine priming state, simulating in vivo conditions. The percentage of all activated PMN, expressed by the total migration index (TMI) reflected the highest median immediately after surgery (Zmax = 30.1%) and dropped to the lowest value on day 13 (Zmin = 13.9%). The mean invasion depth (T/2) of the cells along the migration distance into the filter showed only slight variations over time. The neutrophil migration activity (NMA), described by T/2 and TMI, behaved in a similar way to TMI. In studying physiological healing, preliminary results indicate that TMI, which expresses PMN activation, is an efficient tool in the postoperative monitoring of patients, and might in the future serve as a basis for an early warning system for wound healing complications.

Can the increasing weight of Australians be explained by the decreasing prevalence of cigarette smoking?

In Australia there has been a recent increase in the body mass index (BMI) of the population and a decrease in smoking prevalence. Data from the three risk factor prevalence surveys conducted by the National Heart Foundation of Australia in 1980, 1983 and 1989 were analysed to determine if the increase in BMI could be explained by the decrease in smoking. For men in all age groups and for women aged 50 years or over, there were parallel increases in mean BMI for current smokers, ex-smokers and never smokers. For women under 50 years, the pattern of increasing BMI over time was less clear. Mean BMI increased over time within each five-year age group and in age 'cohorts' and the pattern was independent of smoking status. For men and for both groups of women there were similar changes in mean BMI over time for most categories of employment status, education and physical activity. Thus the increase in body weight cannot be explained by the decrease in smoking rate, or by the other factors investigated in this paper.

Quantitative assessment of carotid atherosclerosis in a healthy population

To evaluate the prevalence and extent of carotid atherosclerosis in a general healthy population, duplex ultrasound imaging was performed in 909 men and women aged 40-79 years as part of the prospective Bruneck Ischemic Heart Disease and Stroke Prevention Study. Atherosclerotic lesions were found in 47.8% of men and 36.3% of women. Sex differences in the prevalence rates were most pronounced from age 40 to 60 years with a convergence occurring in the 7th decade. The age range of 60-69 years was found to be the crucial period for the development of advanced carotid artery disease. The frequency of internal carotid artery stenosis (> 50%) in elderly men and women (60-79 years) was 10.5 and 5.5%. In nonstenotic carotid artery disease the lumen diameter turned out to be a useful indirect measure of the vascular status.

Quit and win smoking cessation contests: how should effectiveness be evaluated?

BACKGROUND

In societies where there are both multiple influences on smoking cessation and a downward secular cessation trend, the attribution of cessation effects to particular interventions poses challenging evaluation problems. Quit smoking lotteries are gaining popularity as mass-reach smoking cessation strategies. Most published evaluations of the lotteries have reported impressive cessation rates within samples of entrants. However, none has considered the possibility that the lotteries merely concentrate a secular quitting trend around a researched event or whether they increase the cessation rate of the whole community from which entrants derive.

RESULTS

Results from a lottery run in a smoking population (n = 101,277) are presented. Of the 1,167 people who entered, 29.2% self-reported being smoke-free at 4 months. These results are considered against a prediction that the campaign might increase the cumulative background 4-month quit rate (708/101,277 or 0.7%) by a minimum of 10%.

CONCLUSION

It is concluded that such a realistic hope, even if achieved, could in practice never be measured. Implications for evaluating the impact of discrete health promotion evaluations in large communities are discussed in terms of the dilemmas posed by the case study.

Echocardiographic diagnosis of fistula between the left circumflex coronary artery and the left atrium

This report describes a case of fistula between the left circumflex coronary artery and the left atrium, which was identified by color flow mapping. This finding was confirmed by selective coronary arteriography.

The case for using waist to hip ratio measurements in routine medical checks

OBJECTIVE

To provide a rationale for using waist:hip ratio (WHR) measurements in clinical practice.

DATA SOURCES

The article reviews the literature on body fat distribution back to the mid 1950s.

STUDY SELECTION

Studies are reviewed which show a clear association between abdominal obesity and a range of ailments including coronary events, hypertension, blood lipid levels, cholecystectomy, diabetes and gallbladder disease.

DATA EXTRACTION

Key data on the correlation of body fat distribution and health risks are summarised.

DATA SYNTHESIS

Abdominal fat measured by a WHR may be a better single predictor of many diseases than other risk factors such as overall obesity, hypertension, smoking, or hypercholesterolaemia.

CONCLUSIONS

The association between WHR and risk indicators appears to be "dose" related, and independent of sex, race and age. High WHRs, however, are more characteristic of men with lower socioeconomic status, whereas weight control programs are more commonly developed for women. A reorientation of weight control initiatives based on health rather than aesthetic priorities is needed. Measurement of WHR should be a routine part of clinical assessments. The predictability of the measure can be improved by combining it with a measure of body mass.

Possible involvement of myeloperoxidase in lipid peroxidation

1. Exposure of liposomes to the MPO-H2O2-Cl- system results in oxidation of lipids. Malondialdehyde and 4-hydroxynonenal are formed. 2. Oxidation of liposomes by stimulated rat neutrophils, assessed by malondialdehyde formation, is inhibited by KCN. This indicates involvement of MPO in the process. 3. The MPO-H2O2 system oxidizes mildly LDL but in the presence of chloride a propagation phase, with a rapid increase of conjugated diene formation, was observed.

"Bread: it's a great way to go". Increasing bread consumption decreases laxative sales in an elderly community

OBJECTIVE

To test the effects on laxative sales of two methods of promoting increased consumption of wholemeal/wholegrain bread by the elderly.

DESIGN

Community intervention trials were carried out in two test communities and one control community on the mid-north coast of New South Wales.

PARTICIPANTS

Small retirement communities with a high proportion of the population aged over 55 years.

INTERVENTIONS

A community organisation strategy (COS) involving the media, community activities and social marketing principles using the theme "Bread: It's a Great Way to Go" was compared with a patient education strategy (PES) through local doctors and a control community (CON).

MAIN OUTCOME MEASURES

Wholemeal/wholegrain bread sales and laxative sales.

RESULTS

There was a 49% decrease in laxative sales corresponding to a 58% increase in sales of wholemeal/wholegrain bread in the COS community but no significant changes in either the PES or CON communities.

CONCLUSIONS

The study suggests a positive, cost effective approach for increasing fibre intake and improving gastrointestinal problems in the elderly.

Nephrotoxicity of fumaric acid monoethylester (FA ME)

The nephrotoxic actions of high single oral doses of fumaric acid monoethylester (FA ME) have been investigated in the rat. Fifty mg of this substance produced morphologic lesions of the glomeruli without reducing GFR. Following 100 mg, the lesions were more pronounced and GFR was diminished by about 40%. Despite of hemorrhages in kidney cortex the urines did not contain erythrocytes. Urinary protein was augmented in single cases only. Fifty to 100 mg FA ME induced a marked concentration defect after water deprivation. In parallel FA ME reduced lactate production from glucose by kidney inner medulla in vitro. After in vivo application, however, no morphologic lesions were found in this zone of the kidney. FA ME had no effect on oxygen consumption of kidney slices despite of proximal tubular lesions observed histologically after 100 mg orally. Thus, 100 mg of FA ME have distinct nephrotoxic effects in the rat.

[The use of sustained-release preparations for eye-platelet diagnosis for noninvasive determination of leukocyte migration in the eye]

An in vivo method for measuring leukocyte migration in man involves the insertion of membrane filter platelets into the lower conjunctival sac. Before insertion, the filter platelets were soaked in solutions of chemotactic test substances and dried. The chemotactic gradient formed by a dissolving test substance stimulates leukocytes from the conjunctival mucosa to immigrate into a filter platelet. The number and the distribution of immigrant cells within the filter platelet yield information on pathological processes. To obtain reliable results, the chemotactic substance used has to show a defined solubility inherent in only a minority of all substances in question. In order to stabilize liberation, the chemotactic test substance is introduced together with a hydrogel-forming substance into a filter platelet. Among a series of tested hydrogel-forming substances, the Guar derivative Meyprogat 90 proved to have the best stabilizing capacity. For an exact measurement of liberation, a new in vitro model was developed that simulates the conditions of drug liberation within the conjunctival sac. In vitro as well as in vivo tests with this type of filter platelets proved their qualification for human medicine.

Characteristics of ingress and life span of neutrophils at a site of acute inflammation, determined with the Sephadex model in rats

Neutrophils labelled in vivo with 3H-thymidine accumulate in subcutaneously injected Sephadex, which causes an acute inflammation. Cells die and disintegrate within the Sephadex implants, leaving behind labelled nuclear fragments representing the number of dead cells. The total of immigrated cells and their life span can be calculated from the number of intact cells along with disintegrated cells found in a Sephadex implant. Intensive neutrophil ingress starts after 5 h, and after 6.5 h reaches a maximum of 52 x 10(6) cells per hour. After 11 h, a total of 137 x 10(6) cells has entered a Sephadex implant. The life span varies during the course of the experiment. The shortest life span of 20 min was measured during the period of intensive neutrophil ingress 5.5 h after onset of inflammation. Cellular death and disintegration is evidently due to self-destruction of the cells by peroxidation.

Gastric ulcer: a double blind comparison of 800 mcg misoprostol versus 300 mg ranitidine

Seventy-nine patients with endoscopically confirmed gastric ulcers received either ranitidine (37 patients) or misoprostol (42 patients) in a randomized double-blind manner. Fifty-six percent of the patients treated with ranitidine, and 38% of those treated with misoprostol presented with endoscopically healed ulcers after four weeks of treatment. After eight weeks complete healing had occurred in 86% of the patients receiving ranitidine, and 74% of those on misoprostol. These differences were not statistically significant. In smokers, ranitidine was superior to misoprostol, leading to a higher healing rate at four weeks (73% versus 20%). Thus there was no evidence that in patients with gastric ulcer misoprostol overcomes the negative effect of cigarette smoking.

Presenting characteristics of patients with duodenal ulcer and outcome of medical treatment in controlled clinical trials using cimetidine and diethylamine persilate to treat ulcer attack and diethylamine persilate and placebo to prevent relapses

A double-blind controlled clinical trial on the medical treatment of the acute episode of duodenal ulcer and the prevention of symptomatic relapses was performed. A total of 164 patients with active duodenal ulcer were either treated with cimetidine 1 g/day (70 patients), diethylaminepersilate (DAP) 1.5 g/day (64 patients) or DAP 2.5 g/day (30 patients). DAP is an allegedly protective agent stimulating mucosal prostaglandin synthesis. Cumulative healing rates after 4 weeks in the 3 groups were 66, 28 and 28% and after 8 weeks 94, 70 and 63%, respectively. One hundred and five patients with healed duodenal ulcer received, in a second double-blind study, either DAP 0.5 g/day or placebo. Thus, ulcer healing was more rapid with cimetidine than with DAP. DAP did not prevent relapses. No presenting characteristic was associated with slow healing. Three presenting characteristics--smoking, teetotalling and bleeding episode in the past--were associated with early symptomatic relapse. The present study was compared with a previous study performed by the same group of investigators using a similar study protocol. In both trials, an early relapse was associated with smoking. No other presenting characteristic was identified which in both trials was associated with slow healing or early symptomatic relapse. Thus, smoking appears to be the only one of the commonly available presenting characteristics which allows a prediction of the course of duodenal ulcer disease.