Phenomenological experience personality profile: A test to identify the affective dimensions of psychopathology in the context of precision psychotherapy

Introduction

Artificial intelligence algorithms are increasingly used to highlight refined qualifiers of pathologies and to build treatment protocols based on them. These possibilities open up new perspectives for personalized interventions in psychotherapy. The affective neurosciences that link psychopathological phenomena to the hypersensitization of emotional systems are an excellent field of application of deep learning algorithms

Objectives

In this contribution we present the standardization of a psychodiagnostic test that can be analyzed with a deep learning algorithm for the development of personalized treatments for depressive disorders in a perspective of precision psychotherapy

Methods

Previously we have constructed a psychodiagnostic test that correlates the psychopathological characteristics to the emotional systems described in affective neuroscience. The construction of this test was carried out with the use of a neural network that discriminated 161 items from a pull of 300 psychopathological and character descriptions. In the present work, the 161 selected items were compared, in a sample of 600 subjects, with the measurement of sadness described in the Panksepp model. Comparation was performed with linear and non-linear statistical analysis methods.

Results

The items emerging from the statistical analyzes as strongly indicative of a hypersensitivity of the sadness system outline a psychopathological profile for which it is possible to adapt specific psychotherapeutic treatment protocols.

Conclusions

In future prospect, neurobiological and psychophysiological variables such as heart rate variability, skin conductance and activity of the areas of the cortex, measured with a scanner of the near infrared photons, will be correlated to these descriptors of psychopathology.

Biodistribution and intracellular localization of hyaluronan and its nanogels. A strategy to target intracellular S. aureus in persistent skin infections

Intracellular pathogens are a critical challenge for antimicrobial therapies. Staphylococcus aureus (S. aureus) causes approximately 85% of all skin and soft tissue infections in humans worldwide and more than 30% of patients develop chronic or recurrent infections within three months, even after appropriate antibacterial therapies. S. aureus is also one of the most common bacteria found in chronic wounds. Recent evidences suggest that S. aureus is able to persist within phagolysosomes of skin cells (i.e. keratinocytes, phagocytic cells), being protected from both the immune system and a number of antimicrobials. To overcome these limits, nano-formulations that enable targeted therapies against intracellular S. aureus might be developed. Herein, the biodistribution and intracellular localisation of hyaluronan (HA) and HA-based nanoparticles (nanogels, NHs) are investigated, both after intravenous (i.v.) injections (in mice) and topical administrations (in ex vivo human skin). Results indicate HA and NHs accumulate especially in skin and liver of mice after i.v. injection. After topical application on human skin explants, no penetration of both HA and NHs was detected in skin with intact stratum corneum. By contrast, in barrier-disrupted human skin (with partial removal and loosening of stratum corneum), HA and NHs penetrate to the viable epidermis and are taken up by keratinocytes. In mechanically produced wounds (skin without epidermis) they accumulate in wound tissue and are taken up by dermis cells, e.g. fibroblasts and phagocytic cells. Interestingly, in all cases, the cellular uptake is CD44-mediated. In vitro studies confirmed that after CD44-mediated uptake, both HA and NHs accumulate in lysosomes of dermal fibroblasts and macrophages, as previously reported for keratinocytes. Finally, the colocalisation between intracellular S. aureus and HA or NHs is demonstrated, in macrophages. Altogether, for the first time, these results strongly suggest that HA and HA-based NHs can provide a targeted therapy to intracellular S. aureus, in persistent skin or wound infections.

Halting hyaluronidase activity with hyaluronan-based nanohydrogels: development of versatile injectable formulations

Hyaluronan (HA) is among the most used biopolymers for viscosupplementation and dermocosmetics. However, the current injectable HA-based formulations present relevant limitations: I) unmodified HA is quickly degraded by endogenous hyaluronidases (HAase), resulting in short lasting properties; II) cross-linked HA, although shows enhanced stability against HAase, often contains toxic chemical cross-linkers. As such, herein, we present biocompatible self-assembled hyaluronan-cholesterol nanohydrogels (HA-CH NHs) able to bind to HAase and inhibit the enzyme activity in vitro, more efficiently than currently marketed HA-based cross-linked formulations (e.g. Jonexa™). HA-CH NHs inhibit HAase through a mixed mechanism, by which NHs bind to HAase with an affinity constant 7-fold higher than that of native HA. Similar NHs, based on gellan-CH, evidenced no binding to HAase, neither inhibition of the enzyme activity, suggesting this effect might be due to the specific binding of HA-CH to the active site of the enzyme. Therefore, HA-CH NHs were engineered into injectable hybrid HA mixtures or physical hydrogels, able to halt the enzymatic degradation of HA.

Large Cell Neuroendocrine Carcinoma of the Lung

Large cell neuroendocrine (LCNE) carcinomas of the lung are a newly recognized, highly aggressive and frequently misdiagnosed entity. We report a case of stage I LCNE lung carcinoma initially misdiagnosed as large cell undifferentiated carcinoma or poorly differentiated adenocarcinoma. The tumor was very extensively necrotic and its neuroendocrine differentiation was only demonstrable with immunohistochemical staining with PHE-5 monoclonal antibody and with antisera against synaptophysin and calcitonin. ACTH, somatostatin and neurofilaments were not demonstrable. The clinical course was ominous and the patient died within 17 months. The reason for this rapid fatal outcome could be ascribed either to the neuroendocrine phenotype of the tumor, or to the extensive necrosis, or both.

Plasma and Tissue Distribution of Adriamycin in Patients with Pelvic Cancer

The levels of adriamycin in plasma, ascitic fluid and normal and neoplastic tissues sampled during surgery of 3 patients with advanced pelvic cancer were measured by fluorimetry. The highest content of fluorescent compounds was found in tumoral masses in necrotic or scarcely viable tissue; viable and invasive tumor areas scored fluorescence levels comparable with normal adnexa. Ascitic fluid contained levels of fluorescence comparable to the last observed phase of plasma levels. Adipose and cutaneous tissue scored the lowest concentrations.

Bronchial Carcinoid with S-100 Positive Sustentacular Cells

A case of double bronchial typical carcinoid of the central type, with a nodal metastasis and paraneoplastic Cushing syndrome is reported. The case is remarkable because both the primary tumors and nodal metastasis were composed of a duoble cell population: one was arranged in nests, was argyrophilic, immunostained with PHE-5 monoclonal antibody, and contained neurosecretory granules; the other one was neither argyrophilic nor PHE-5-immunoreactive, but was strongly immunoreactive for S-100 protein, had a stellate morphology and was at the periphery of the nests of the other cells. The S-100 immunoreactive cells were regarded as a sort of « sustentacular » or « satellite » cells, which are themselves neoplastic. Bronchial carcinoids with S-100 positive cells, although strictly related with other bronchial carcinoids, may in fact represent a group of tumors with different histogenesis and/or differentiative pattern. More work should be done to elucidate whether there is any relevant clinical difference between bronchial carcinoids with or without S-100 reactive cells.

Early Glial Tumor Metastases through a Ventriculo-Atrial Shunt

A girl of 12 with a pontine polymorphous astrocytoma diffusely metastasizing to the spinal cord leptomeninges suddenly died 20 hours after the insertion of a right ventriculo–atrial shunt. Many severely damaged glial neoplastic cells were found in the blood vessels of the lung and liver.

Erythrocyte's aging in microgravity highlights how environmental stimuli shape metabolism and morphology

The determination of the function of cells in zero-gravity conditions is a subject of interest in many different research fields. Due to their metabolic unicity, the characterization of the behaviour of erythrocytes maintained in prolonged microgravity conditions is of particular importance. Here, we used a 3D-clinostat to assess the microgravity-induced modifications of the structure and function of these cells, by investigating how they translate these peculiar mechanical stimuli into modifications, with potential clinical interest, of the biochemical pathways and the aging processes. We compared the erythrocyte's structural parameters and selected metabolic indicators that are characteristic of the aging in microgravity and standard static incubation conditions. The results suggest that, at first, human erythrocytes react to external stimuli by adapting their metabolic patterns and the rate of consumption of the cell resources. On longer timeframes, the cells translate even small differences in the environment mechanical solicitations into structural and morphologic features, leading to distinctive morphological patterns of aging.

HLA-DRB1*15 association with multiple sclerosis is confirmed in a multigenerational Italian family

Environmental and genetic factors seem to play a pathogenetic role in multiple sclerosis (MS). The genetic component is partly suggested by familial aggregation of cases; however, MS families with affected subjects over different generations have rarely been described. The aim of this study was to report clinical and genetic features of a multigenerational MS family and to perform a review of the literature on this topic. We describe a multigenerational Italian family with six individuals affected by MS, showing different clinical and neuroradiological findings. HLA-DRB1* typing revealed the presence of the DRB1*15:01 allele in all the MS cases and in 4/5 non-affected subjects. Reports on six multigenerational MS families have previously been published, giving similar results. The HLA-DRB1*15:01 allele was confirmed to be linked to MS disease in this family; moreover, its presence in non-affected subjects suggests the involvement of other susceptibility factors in the development and expression of the disease, in accordance with the complex disease model now attributed to MS.

Unusual Coexistence of Bilateral Keratoconus and Optic Disc Pit: A Case Report

Purpose

To report the unknown coexistence of bilateral optic disc pit and keratoconus.

Methods

A 23-year-old man with bilateral keratoconus underwent complete ophthalmology screening, with an unexpected detection of undiagnosed optic disc pit in both eyes. Computerized corneal topography (CT), Orbscan, corneal pachometry, endothelial microscopy, and optical coherence tomography (OCT) examination were performed.

Results

The corneal CT showed a keratoconus pattern in both eyes, evolved in the right eye with a minimum corneal pachometry of 336 μm in the right eye and 405 μm in the left eye. Mean endothelial cell density was 1937 cells/mm2 in the right eye and 1912 cells/mm2 in the left eye. The OCT scans showed the presence of the disc pit in both eyes with a normal macular thickness and profile in the right eye, and in the left eye an augmented retinal thickness in the nasal macular zone due to retinal oedema and schisis, with an initial detachment of the neuroepithelium in the parapapillary area starting from the optic pit.

Conclusions

This is the first clinical report of bilateral optic disc pit and keratoconus. Further investigations will be necessary to assess if there is a possible pathogenetic correlation between these two ocular pathologies or if this is an unusual coexistence of separate entities.

Endometrial cancer in unicornuate uterus: a case report

PURPOSE OF INVESTIGATION

Miillerian anomalies have not been implicated as a significant risk factor for the development of cervical, uterine, and ovarian cancers; in the present literature, there are only a few reports of endometrial cancer arising in patients with Miillerian abnormalities. To the best of the authors' knowledge, this is the first reported case of endometrial cancer arising in a patient with unicornuate uterus.

CASE REPORT

A 69-year-old Caucasian woman underwent clinical examination and office hysteroscopy with endometrial biopsy because of abnormal post-menopausal bleeding. The diagnosis was endometrial cancer in unicornuate uterus, hence the patient underwent total hysterectomy with pelvic lymphadenectomy.

CONCLUSION

Uterine malformations and genetic disorders may cause a delayed diagnosis of gynaecological cancers. Gynaecological examination in asymptomatic patients and differential diagnosis in abnormal uterine bleeding patients should be considered.

Amyotrophic lateral sclerosis in pregnancy is associated with a vascular endothelial growth factor promoter genotype

BACKGROUND AND PURPOSE

The occurrence of amyotrophic lateral sclerosis (ALS) during pregnancy is uncommon and the effect of one on the other is not well described.

METHODS

The clinical and genetic features of five cases of ALS are reported with an onset during pregnancy or within 1 month from delivery. Charts from 239 women with a diagnosis of ALS attending the neuromuscular clinics at the Neuromuscular Omnicentre (NEMO) and at IRCCS Policlinico San Donato from 2008 to 2011 were reviewed.

RESULTS

Of these, 12.8% of the women in child-bearing age had a diagnosis of ALS during pregnancy or immediately after delivery. Genetic screening of the major causative genes revealed two mutations in superoxide dismutase 1 (SOD1) gene; the analysis of vascular endothelial growth factor (VEGF) promoter variation showed a segregation of the haplotype CA/AG (-2578C/A; -1190A/G) in patients developing ALS related to pregnancy. No effects on foetal development or neonatal course were observed.

CONCLUSIONS

Pregnancy may unmask ALS but whether this is coincidental is unclear. Hormonal and inflammatory modifications might trigger ALS in subjects with increased susceptibility to oxidative stress related to the toxic function of SOD1 or in subjects with a reduction of neuroprotective molecules such as VEGF.

Reduction in dietary trans fat intake is associated with decreased LDL particle number in a primary prevention population

BACKGROUND AND AIMS

Increased trans fat intake has been associated with an increased risk of cardiovascular disease (CVD). While the effect of trans fat on traditional lipids is known, it's association with LDL particle number (LDL-P), a novel marker of CVD risk, has not been established. The purpose of this study was to determine the association between trans fat intake and LDL-P over 1-year among individuals participating in a lifestyle intervention trial.

METHODS AND RESULTS

Family members (N = 400, 33% male, mean age 48 ± 13) of patients hospitalized with CVD who participated in a 1-year randomized controlled primary prevention lifestyle intervention trial and had complete dietary data and LDL-P measures at baseline and 1-year. Change in trans fat as a percentage of total diet and mean absolute change in LDL-P at 1-year was assessed using multivariate adjusted linear regression models. At baseline, there was a significant positive correlation between dietary trans fat intake and LDL-P (Beta = 37, p = 0.04). For every 1 percent change in trans fat intake there was a 27 nmol/L change in LDL-P (Beta = 27, p = 0.04) over 1-year which was independent of baseline predictors and confounders (age, sex, smoking, statin use, waist size and physical activity; Beta = 30, p = 0.03).

CONCLUSION

A reduction in trans fat intake over 1-year was significantly associated with a reduction in LDL-P independent of potential confounders. Healthcare providers should reinforce the beneficial impact of a healthy diet, and in particular modifications in trans fat intake on improving lipid profiles.

Benign pulmonary metastasizing leiomyomatosis: case report

The authors report a rare case of leiomyomatosis of the lung diagnosed in a 43-year-old woman, with uterine intravenous leiomyomatosis. Benign metastasizing leiomyoma (BML) is an extremely rare lesion characterized by usually multiple, benign-appearing smooth muscle tumors of the lung in females with coexisting uterine leiomyoma. On the basis of their histological and immunohistological features, a unified histogenetic view of leiomyomas with vascular invasion (LWVI) and BML of the uterus is proposed. LWVI and BML may be the same pathological entity and microscopic vascular invasion may represent the metastatic mechanism of BML. LWVI seems to be the precursor of BML.

Vaginal microbiota and viral sexually transmitted diseases

Healthy vaginal microbiota is an important biological barrier to pathogenic microorganisms. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with prevalence and incidence of several sexually transmitted infections. This review provides background on BV, discusses the epidemiologic data to support a role of altered vaginal microbiota for acquisition of sexually transmitted diseases and analyzes mechanisms by which lactobacilli could counteract sexually transmitted viral infections.

The expression pattern of small nucleolar and small Cajal body-specific RNAs characterizes distinct molecular subtypes of multiple myeloma

Small nucleolar RNAs (snoRNAs) and small Cajal body-specific RNAs (scaRNAs) are non-coding RNAs involved in the maturation of other RNA molecules and generally located in the introns of host genes. It is now emerging that altered sno/scaRNAs expression may have a pathological role in cancer. This study elucidates the patterns of sno/scaRNAs expression in multiple myeloma (MM) by profiling purified malignant plasma cells from 55 MMs, 8 secondary plasma cell leukemias (sPCLs) and 4 normal controls. Overall, a global sno/scaRNAs downregulation was found in MMs and, even more, in sPCLs compared with normal plasma cells. Whereas SCARNA22 resulted the only sno/scaRNA characterizing the translocation/cyclin D4 (TC4) MM, TC2 group displayed a distinct sno/scaRNA signature overexpressing members of SNORD115 and SNORD116 families located in a region finely regulated by an imprinting center at 15q11, which, however, resulted overall hypomethylated in MMs independently of the SNORD115 and SNORD116 expression levels. Finally, integrative analyses with available gene expression and genome-wide data revealed the occurrence of significant sno/scaRNAs/host genes co-expression and the putative influence of allelic imbalances on specific snoRNAs expression. Our data extend the current view of sno/scaRNAs deregulation in cancer and add novel information to the bio-molecular complexity of plasma cell dyscrasias.

Myocardial blood flow and flow reserve in response to hormone therapy in postmenopausal women with risk factors for coronary disease

Estrogen has beneficial effects on markers of coronary heart disease (CHD) risk, but may increase overall CHD events. The effects of hormone therapy on vascular endothelial function have been mixed, and require further assessment. We studied the myocardial blood flow (MBF) response to postmenopausal combination hormone therapy (CHT) in postmenopausal women with risk factors for CHD. We performed dynamic [13N]ammonia positron emission tomography in 15 postmenopausal women in a 7-month placebo-controlled crossover trial of continuous conjugated equine estrogen/cyclical micronized progesterone. MBF was measured at rest, after sympathetic stimulation with the cold pressor test (CPT), and after i.v. adenosine infusion, to determine baseline, endothelium-dependent, and maximal flows, respectively. Response to CPT was neutral in all women at baseline (-0.51 +/- 27%). Adenosine induced a marked increase in MBF (161 +/- 111%). Treatment with 3 months of combined estrogen/progestin CHT did not change CPT or adenosine MBF responses. Myocardial flow reserve was unchanged as well. In this group of postmenopausal women at higher cardiovascular risk, no association was found between CHT assignment and change in MBF. Further study is needed to clarify the effects of CHT on the endothelium of women with presumably diseased vasculature.

Setting a local research agenda for women's health: The National Centers of Excellence in Women's Health

Although women's health research expanded greatly in the past 10 years, significant gaps in knowledge remain. Prioritization and promotion of research will help assure continuing progress in closing such gaps and improving the health of women. Although a comprehensive agenda for the new millennium has been developed at the national level, the process for establishing a local research agenda is not well defined. The purpose of this study was to describe criteria for and barriers to establishing a local research agenda in women's health. A secondary aim was to describe mechanisms for identifying women's health researchers and for facilitating multidisciplinary research. Directors of Research at National Centers of Excellence in Women's Health (CoEs) (n = 18) were surveyed by mail for this information. The results indicate that the local research agenda should emphasize health issues that are prevalent in women, research that is likely to establish treatment, psychosocial/cultural factors, and quality of life issues. The process of setting a research agenda should include input from the communities served as well as from scientists. Critical evaluation of scientific strengths and weaknesses is an essential preliminary step in prioritizing research opportunities in order to implement and evaluate a research agenda in women's health.

Association between self-reported physical activity and vascular reactivity in postmenopausal women

Short-term exercise training has been associated with improved endothelial-dependent vasodilation, but the impact of long-term habitual physical activity on vascular reactivity is not established. We studied the correlation between self-reported, habitual physical activity and vasoreactivity in non-smoking, non-diabetic, postmenopausal women (n=34, mean age 65.6+/-7.4 years). Vasoreactivity was evaluated by the percentage and absolute change in brachial artery diameter in response to reactive hyperemia induced by occlusion-release, and in response to cold pressor testing (CPT). Habitual physical activity was assessed by a standardized questionnaire based on participant recall. Our results indicate that 64.7% of the women were exercising-to-sweat > or =1x/week, 4.8 flights of stairs were climbed/day, 5.0 city blocks were walked/day and 29.4% participated in moderately physically demanding daily activity. There was a significant association between the number of city blocks walked daily and exercising-to-sweat > or =1x/week with brachial artery percentage and absolute change to CPT (P<0.05). Women who reported a moderately physically demanding daily activity had a significantly greater brachial reactivity percentage change in response to CPT compared with those performing less demanding daily activity (2.0+/-3.6 versus 1.4+/-7.0%, P<0.05). The response to reactive hyperemia was also greater in those women reporting moderately physically demanding daily activity compared to less active women (6.5+/-5.4 versus 5.8+/-5.9%, P=n.s.), but this did not reach statistical significance. Stepwise, multivariate analysis adjusting for body mass index and HDL-cholesterol eliminated the association between physical activity and brachial reactivity in response to CPT, suggesting that physical activity may affect vasoreactivity via these mechanisms. This study suggests that moderate levels of self-reported physical activity are associated with a greater brachial reactivity in response to CPT and supports the recommendation that moderate intensity physical activity may be cardioprotective in postmenopausal women.

Rationale and overview of the Raloxifene Use for the Heart (RUTH) trial

Raloxifene is a selective estrogen receptor modulator (SERM) that has beneficial effects on several cardiovascular risk factors and has also been associated with a reduced risk of breast cancer in osteoporosis prevention trials. The Raloxifene Use for the Heart (RUTH) study was designed to test the hypothesis that, compared to placebo, raloxifene at 60 mg/day (1) lowers the risk of the combined end point of coronary death, nonfatal myocardial infarction (MI), and hospitalized acute coronary syndromes other than MI and (2) reduces the risk of invasive breast cancer (coprimary end point) in women at high risk for major coronary events based on established cardiovascular disease (CVD) or multiple risk factors. RUTH is a double-blind, placebo-controlled, randomized, clinical trial of 10,101 women aged 55 years or older from 26 countries and is expected to be completed in approximately 5 years.

Variability in fibrinogen measurements: an obstacle to cardiovascular risk stratification

The clinical utility of fibrinogen measurement has been limited by large intraindividual variability. Several approaches that have been shown to improve the repeatability of fibrinogen include acquisition of samples at the same time of day, standardized sample procurement techniques, and multiple replicate sampling. This study employed established pre-analytical and analytical techniques known to reduce fibrinogen variability, including the acquisition of three replicate samples, each analyzed in duplicate, to evaluate the impact of intraindividual variability in fibrinogen measurement at baseline and 3 months on cardiovascular risk in 60 healthy subjects. Classification accuracy was evaluated by the ability to categorize subjects into tertiles of fibrinogen. Only 55% (33/60) of the subjects were correctly assigned to the appropriate fibrinogen tertile. Fibrinogen measurements varied by more than 10% in 45% of subjects and by 5% in 80% of subjects. Intraindividual variability in fibrinogen measurement with a functional assay limits cardiovascular risk assessment even when three replicates are averaged.

An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women

BACKGROUND

Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas.

OBJECTIVE

To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition.

PARTICIPANTS AND METHODS

A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms.

RESULTS

Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001).

CONCLUSIONS

Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.

Effect of raloxifene on serum triglycerides in postmenopausal women: influence of predisposing factors for hypertriglyceridemia

BACKGROUND

Estrogen increases serum triglyceride (TG) levels and induces hypertriglyceridemia in susceptible women. The effect of raloxifene (RLX), a selective estrogen-receptor modulator, on serum TG has not been studied in detail.

OBJECTIVE

The purpose of this study was to examine the effect of RLX on serum TG levels in postmenopausal women with and without osteoporosis, including those with predisposing factors for hypertriglyceridemia.

METHODS

Fasting serum TG levels were assessed over 36 months in 2738 osteoporotic postmenopausal women (mean age, 67 years) assigned to placebo or RLX (60 or 120 mg/d) in an osteoporosis treatment trial and over 24 months in 1318 postmenopausal women without osteoporosis (mean age, 54 years) assigned to placebo or RLX (60 or 150 mg/d) in 3 osteoporosis prevention trials.

RESULTS

In the osteoporosis treatment trial, the median serum TG concentration decreased in all groups, but significantly more in the placebo group (placebo, -3.4%; RLX 60 mg/d, -1.4%; RLX 120 mg/d, -1.3%; P = 0.002). In the osteoporosis prevention trials, the percentage change in median serum TG concentration was not significantly different among treatments (P = 0.22). Among women with varying degrees of hypertriglyceridemia at baseline (>2.82, >3.39, and >4.51 mmol/L), the median serum TG level at the end of the study decreased from baseline in all groups, with no significant differences among treatments (P > or = 0.13). The effect of RLX on serum TG level was not influenced by age, smoking status, use of alcohol, or presence of diabetes (P > or = 0.10 for all interactions). Among women in the highest tertile of body mass index (>26.4 kg/m2), RLX increased serum TG levels significantly compared with placebo (placebo, -3%; RLX 60 mg/d, 6%: RLX 120 mg/d, 4%; P < 0.05); the absolute increase from baseline with RLX in this subgroup was 0.05 mmol/L (4.4 mg/dL).

CONCLUSIONS

RLX did not increase serum TG in postmenopausal women overall or among women with elevated TG levels or evidence of diabetes at baseline. TG levels increased slightly but statistically significantly in women in the upper tertile of body mass index who were treated with RLX.

Design and methods of the Raloxifene Use for The Heart (RUTH) study

Raloxifene is a selective estrogen receptor modulator that lowers total and low-density lipoprotein (LDL) cholesterol, reduces the risk of vertebral fracture, and is associated with a reduced incidence of invasive breast cancer in postmenopausal women with osteoporosis. The Raloxifene Use for The Heart (RUTH) trial is designed to determine whether raloxifene 60 mg/day compared with placebo: (1) lowers the risk of the coronary events (coronary death, nonfatal myocardial infarction [MI], or hospitalized acute coronary syndromes other than MI); and (2) reduces the risk of invasive breast cancer in women at risk for a major coronary event. RUTH is a double-blind, placebo-controlled, randomized clinical trial of 10,101 postmenopausal women aged > or =55 years from 26 countries. Women are eligible for randomization if they are postmenopausal and have documented coronary heart disease (CHD), peripheral arterial disease, or multiple risk factors for CHD. Use of estrogen within the previous 6 months is an exclusion factor. The study will be terminated after a minimum of 1,670 participants experience a primary coronary end point. Secondary end points include cardiovascular death, myocardial revascularization, noncoronary arterial revascularization, stroke, all-cause hospitalization, all-cause mortality, all breast cancers, clinical fractures, and venous thromboembolic events, in addition to the individual components of the composite primary coronary end point. RUTH will provide important information about the risk-benefit ratio of raloxifene in preventing acute coronary events and invasive breast cancer, as well as information about the natural history of CHD in women at risk of major coronary events.

Interaction of enkephalins with oxyradicals

The interaction of enkephalins (leu-enkephalin and met-enkephalin) and other tyrosine amino-terminal peptides with reactive oxygen species has been investigated. All the peptides tested exhibited hydroxyl radical and superoxide anion scavenging ability and the capacity to reduce the rate of lipid peroxidation induced by 2,2'-azobis(2-amidinopropane). The scavenging activity was observed in the 0.1-1 mM concentration range. It has been observed that enkephalins underwent an oxidative modification by Fenton systems. The tyrosine amino-terminal residue was attacked by hydroxyl radical, being converted to dopa. The overall transformation produced opiomelanin pigments. This oxidative process provides evidence of a possible route for opiomelanin synthesis without any enzyme intervention.

Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention

A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made.

Usefulness of brachial artery reactivity to isometric handgrip exercise in identifying patients at risk and with coronary artery disease

The change in brachial artery (BA) diameter after release of an occluding cuff has been used as a measure of endothelial function, to characterize atherosclerotic risk factors, and as a surrogate marker for coronary artery disease (CAD). We compared the change in BA diameter to isometric handgrip (IHG) with the occlusion release method to determine if a physiologic stress could be used to distinguish patients at risk and with CAD. BA diameter was measured by ultrasound during and after IHG, and after occlusion release in 93 subjects. At 120 seconds after release of IHG, BA diameter increased by 9.99 +/- 8.3% (p <0.001) in 26 average-risk patients, increased 1.84 +/- 5.7% in 37 high-risk patients, and decreased 3.9 +/- 5.6% in 30 patients with CAD (p = 0.0001 for trend and p < 0.01 between groups). There was a good correlation between change in BA diameter to IHG and occlusion release (r = 0.763 and p = 0.0001). The capacity for IHG and BA occlusion to characterize subjects by group was comparable with the exception of high-risk patients versus patients with CAD (80.5% for IHG vs 71.6% for occlusion and release, p = 0.086). BA response to IHG may be useful for identifying risk factors, patients at risk and with preclinical CAD, and the assessment of treatment strategies.

Carotid artery vasoreactivity in response to sympathetic stress correlates with coronary disease risk and is independent of wall thickness

OBJECTIVES

We designed a study to determine the carotid artery (CA) response to sympathetic activity and to determine whether the response correlates with coronary risk and is independent of wall thickness (IMT).

BACKGROUND

Brachial artery reactivity in response to wall stress correlates with coronary risk and coronary disease (CAD). The reactivity of the CA, which is susceptible to atherosclerosis, has not been evaluated.

METHODS

The change in diameter of the CA (deltaCAdiam) during a cold pressor test and after nitroglycerin and IMT were measured with ultrasound in 93 men and women at average risk, high risk and with CAD.

RESULTS

At 90 s during a cold pressor test average-risk subjects increased CAdiam by 7.9+/-3.3%, which was significantly less in the high-risk group (1.5+/-1.8%), and vasoconstriction occurred in the group of subjects with CAD (-6.9+/-2.7%) (p < 0.01 for comparisons). There were no differences in response to nitroglycerin. Coronary risk was an independent predictor of the %deltaCAdiam (p < 0.0001). Wall thickness, age, systolic pressure and triglycerides each correlated negatively, and high-density lipoprotein cholesterol correlated positively with %deltaCAdiam. The major variable associated with the %deltaCAdiam, was group (p = 0.0001). After adjusting for smoking, age and high-density lipoprotein cholesterol, there was no association between the %deltaCAdiam, and IMT and %deltaCAdiam, but not IMT, was predictive of groups.

CONCLUSIONS

The CA response to a sympathetic stimulus is altered in the presence of coronary risk factors and CAD and appears to reflect endothelial function independent of IMT. Carotid artery reactivity may be a valuable adjunctive noninvasive method to assess coronary risk.

The role of hormone replacement therapy in the prevention of postmenopausal heart disease

Coronary heart disease is the single leading cause of death in women and a significant cause of disability. Menopause adversely affects several risk factors for coronary heart disease, suggesting that hormones influence the risk of coronary heart disease in postmenopausal women. This article reviews the observational and clinical trial data evaluating the relation between cardiovascular disease and hormone replacement therapy. Biological mechanisms of estrogen and the impact of adding progestins are emphasized. Potential risks and benefits of therapy are discussed. The relative effects of other estrogen and lipid-lowering therapies for preventing coronary heart disease in postmenopausal women are highlighted.

Prevention of heart disease in women: recommendations for management of risk factors

Coronary heart disease is the leading cause of death and disability in women in the U.S. Unfortunately, efforts for primary and secondary prevention of coronary heart disease are less than optimal. The need to emphasize prevention of coronary heart disease in women in important because first events are often fatal in women. Factors that are unique in terms of their influence on risk for coronary heart disease in women include age, reproductive and hormonal status, high density lipoprotein cholesterol and triglyceride levels, and the presence of diabetes. A consistent plan to address risk factor management of each woman is the key to long term risk reduction. Nurses and nurse practitioners, working in any setting, can use the recommendations presented in this paper to help women reduce their risk for coronary heart disease.

The impact of a disease-management program on the symptom experience of older women with heart disease

This study describes the symptom experience of 570 older women with heart disease and evaluates a disease-management program's impact on symptoms over time. Women were randomly assigned to either usual care or a 4-week program ("Women take PRIDE") designed to improve self-regulation skills by focusing on increasing physical activity. At 4 months follow-up, program women, compared to controls, reported fewer total symptoms (p = 0.01) and decreased symptom frequency (p = 0.02) and bothersomeness (p = 0.02). By 12 months, positive intervention effects emerged within the common cardiac and sleep and rest symptom categories. Program group women reported more improvements in symptoms likely to be affected by increasing physical activity at both follow-ups (p < 0.05).