A lifestyle intervention among elderly men on active surveillance for non-aggressive prostate cancer: a randomised feasibility study with whole-grain rye and exercise

BACKGROUND

The prognosis for men with non-aggressive prostate cancer is good, and several studies have investigated the impact of lifestyle changes including physical activity and diet on the prognosis. Despite positive results in animal studies and a few human interventions with whole-grain rye on markers of prostate cancer progression, the feasibility of trials investigating such dietary changes in combination with physical activity remains largely unstudied. The primary aim was to investigate the feasibility of an intervention with high whole-grain rye intake and vigorous physical activity for 6 months in men diagnosed with prostate cancer.

METHODS

In total, 26 men (53-72 years) recently diagnosed with non-aggressive prostate cancer and on active surveillance, were enrolled in 2011-2012 and randomly assigned to an intervention or a control group. The intervention included 170 g/day of whole-grain rye and 3 × 45 minutes/week of vigorous physical activity. The duration of the intervention was 6 months and end of follow-up 12 months after baseline. Clinic visits were scheduled at baseline and 3, 6 and 12 months after baseline. Compliance with the intervention was evaluated by diaries, food frequency questionnaires, biomarkers, and heart rate monitor data. The effect of the intervention was evaluated by linear multiple regression analysis.

RESULTS

In the intervention group, the mean daily intake of whole-grain rye measured from diaries was 146 g (SD: 19) for the first 3 months and 125 g (SD: 40) for the last 3 months of the intervention. The median level (5th and 95th percentiles) of vigorous physical activity was 91 (17, 193) min/week for the first 3 months and 66 (13, 259) min/week for the last 3 months. No recordings of physical activity were done for the control group. Aerobic fitness (VO2 peak) increased in the intervention group compared to the control group after the intervention. No effects were found on other cardio-metabolic outcomes or prostate cancer progression.

CONCLUSIONS

The lifestyle intervention appeared feasible for 6 months among Danish men and the results are encouraging for conducting full-scale studies, where the impact of whole-grain rye and vigorous physical activity on prostate cancer progression and metabolic parameters can be evaluated.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01300104 . Registered on 18 February 2011.

Sustained virological response following chronic hepatitis C treatment is associated with improvement in insulin resistance

BACKGROUND

Insulin resistance (IR) is a key factor in the development of hepatic steatosis and fibrosis in chronic hepatitis C virus infection. Little is known about the impact of viral clearance on IR.

AIM

The aim of this study was to determine the impact of viral clearance on IR.

METHODS

Eighty-six patients treated according to standard clinical practice at an Australian teaching hospital between 2003 and 2007 were prospectively studied. Demographic, biochemical and histological data were collected.

RESULTS

The mean pretreatment homeostatic model assessment-IR (HOMA-IR) was similar in the sustained virological response (SVR) and non-SVR groups (2.7 ± 0.5 and 2.8 ± 0.4, respectively), and both values were consistent with significant IR. There was a significant improvement in HOMA-IR (from 3.0 ± 1.0 to 2.2 ± 0.5, P = 0.04) at the end of treatment in the SVR group only. This trended towards significance at 6 months post-treatment. Multiple regression analysis found improvement in both gamma-glutamyl transpeptidase and alanine aminotransferase predicted improvement in HOMA-IR when controlled for other potential factors (P = 0.01).

CONCLUSIONS

Hepatitis C virus clearance is associated with improvement in IR. Although baseline hepatic fibrosis is a predictor of IR, changes in IR appear to be independent of changes in liver fibrosis. Treatment-related improvement in gamma-glutamyl transpeptidase and alanine aminotransferase seen with improved IR may be a possible marker of reduction of hepatic oxidative stress.

Effects of smoking and antioxidant micronutrients on risk of colorectal cancer

BACKGROUND & AIMS

Antioxidant intake has been reported to increase the risk of colorectal cancer (CRC) for smokers, yet reduce the risk for nonsmokers. We investigated the association between tobacco smoking and risk of colon or rectal cancer, and whether dietary and supplemental intake of the antioxidant vitamins A, C, E, β-carotene, selenium, zinc, and manganese affects the risk of CRC among smokers.

METHODS

Data on smoking habits and antioxidant intake were analyzed for 54,208 participants in the Danish Prospective Diet, Cancer and Health Study. Of these participants, 642 were diagnosed with colon cancer and 348 were diagnosed with rectal cancer. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazard models. Principal components were used to analyze intake of combinations of antioxidants.

RESULTS

Ever smoking increased the risk for CRC (hazard ratio, 1.19; 95% confidence interval, 1.03-1.37), especially for rectal cancer. Smoking for at least 20 years was associated with a 26% increase in risk of CRC, compared with never smokers, and smoking 20 g tobacco or more each day was associated with a 30% increase in risk. Smoking for more than 30 years, or more than 20 g tobacco each day, was associated with a 48% increase in risk of rectal cancer. We did not observe an interaction between smoking and antioxidant consumption on risk of CRC.

CONCLUSIONS

Tobacco smoking increases the risk for CRC. We did not observe that consumption of antioxidant micronutrients modulates the effects of smoking on CRC risk.

Influence of dietary protein intake and glycemic index on the association between TCF7L2 HapA and weight gain

BACKGROUND

Genetic polymorphisms of transcription factor 7-like 2 (TCF7L2) have been associated with type 2 diabetes and BMI.

OBJECTIVE

The objective was to investigate whether TCF7L2 HapA is associated with weight development and whether such an association is modulated by protein intake or by the glycemic index (GI).

DESIGN

The investigation was based on prospective data from 5 cohort studies nested within the European Prospective Investigation into Cancer and Nutrition. Weight change was followed up for a mean (±SD) of 6.8 ± 2.5 y. TCF7L2 rs7903146 and rs10885406 were successfully genotyped in 11,069 individuals and used to derive HapA. Multiple logistic and linear regression analysis was applied to test for the main effect of HapA and its interaction with dietary protein or GI. Analyses from the cohorts were combined by random-effects meta-analysis.

RESULTS

HapA was associated neither with baseline BMI (0.03 ± 0.07 BMI units per allele; P = 0.6) nor with annual weight change (8.8 ± 11.7 g/y per allele; P = 0.5). However, a previously shown positive association between intake of protein, particularly of animal origin, and subsequent weight change in this population proved to be attenuated by TCF7L2 HapA (P-interaction = 0.01). We showed that weight gain becomes independent of protein intake with an increasing number of HapA alleles. Substitution of protein with either fat or carbohydrates showed the same effects. No interaction with GI was observed.

CONCLUSION

TCF7L2 HapA attenuates the positive association between animal protein intake and long-term body weight change in middle-aged Europeans but does not interact with the GI of the diet.

Altered temporal characteristics of the rectoanal inhibitory reflex in patients with abdominal distension

The rectoanal inhibitory reflex (RAIR) is important in gas and stool evacuation. We examined RAIR features in patients with chronic constipation who exhibited bloating with and without abdominal distension, to determine whether alterations in RAIR may be a factor in the pathogenesis of abdominal distension. Seventy-five female patients with chronic constipation with or without abdominal distension were included in the study. The presence or absence of abdominal distension was assessed according to the Rome II questionnaire. All patients underwent both RAIR and rectal sensitivity testing, and specific RAIR parameters were analyzed. Patients were divided into two groups: abdominal bloating with distension (D, n = 55) and abdominal bloating without distension (ND, n = 20). D had a longer time to the onset of anal sphincter inhibition (latency of inhibition) (P = 0.03) compared with ND. In logistic regression analysis, a combination of age, latency of inhibition and the time measured from onset of inhibition to the point of maximum inhibition predicted abdominal distension (P = 0.002). There were no differences between groups for the time from point of maximum inhibition to recovery and for the percentage of internal anal sphincter relaxation. This is the first study to examine the role of RAIR in patients with abdominal distension. Female patients with constipation and abdominal distension exhibited differences in the temporal characteristics of, but not in the degree of, anal sphincter relaxation compared with patients without distension. Since this study was uncontrolled, further studies are necessary to determine the contribution of altered anorectal reflexes to abdominal distension.

Estimation of lean body weight in older women with hip fracture

OBJECTIVE

Lean body weight (LBW) decreases with age while total body fat increases, resulting in altered drug pharmacokinetics. A semi-mechanistic equation estimating LBW using height, weight and sex has been developed for potential use across a wide range of body compositions. The aim of this study was to determine the ability of the LBW equation to estimate dual energy x-ray absorptiometry-derived fat free mass (FFM(DXA)) in a population of older women with recent hip fracture.

METHODS

Baseline, four and 12 month data obtained from 23 women enrolled in the Sarcopenia and Hip Fracture study were pooled to give 58 measurements. LBW was estimated using the equation: LBW (kg) = (9270 x Wt) / (8780 + (244 x BMI)). Body composition was classified as: 'normal' (BMI <25kg/m(2) and not sarcopenic), 'overweight-obese' (BMI >25kg/m(2) and not sarcopenic), 'sarcopenic' (sarcopenic and BMI <25kg/m(2)), or 'sarcopenic-obese' (sarcopenic and BMI >25kg/m(2)). The ability of the LBW equation to predict FFMDXA was determined graphically using Bland-Altman plots and quantitatively using the method of Sheiner and Beal.

RESULTS

The mean ± SD age of female participants women was 83±7 years (n=23). Sarcopenia was frequently observed (65.2%). Bland-Altman plots demonstrated an underestimation by the LBW equation compared to FFMDXA. The bias (95% CI) and precision (95% CI) calculated using the method of Sheiner and Beal was 0.5kg (-0.7, 1.66kg) and 4.4kg (-3.7, 12.4kg) respectively for pooled data.

CONCLUSION

This equation can be used to easily calculate LBW. When compared to FFMDXA, the LBW equation resulted in a small underestimation on average in this population of women with recent hip fracture. The degree of bias may not be clinically important although further studies of larger heterogeneous cohorts are needed to investigate and potentially improve the accuracy of this predictive equation in larger clinical cohorts.

Prolonged balloon expulsion is predictive of abdominal distension in bloating

OBJECTIVES

Abdominal bloating and distension are common in patients with constipation. The precise mechanism of abdominal distension remains uncertain. We hypothesized that constipated patients with bloating plus distension exhibit a greater degree of anorectal dysfunction, potentially affecting gas evacuation, than those without distension. Therefore, our aim was to evaluate anorectal function and other clinical features in patients with constipation who exhibit bloating with and without distension.

METHODS

In all, 88 female patients with abdominal bloating and either non-diarrhea irritable bowel syndrome (IBS) or functional constipation were included in the study. The presence or absence of abdominal distension was assessed according to the Rome II questionnaire, and all patients underwent comprehensive clinical assessment and anorectal function studies.

RESULTS

Patients were divided into two groups: abdominal bloating with distension (D; n=53) and abdominal bloating without distension (ND; n=35). D featured a prolonged balloon expulsion time (P=0.005), a higher resting anal sphincter pressure (P=0.002), and a higher maximum anal sphincter squeeze pressure (P=0.015) than ND. They also experienced more bloating (P<0.001), more abdominal pain (P=0.004), harder stools (P=0.01), and more incomplete emptying (P=0.005). In logistic regression modeling, prolonged balloon expulsion time was a significant predictor of abdominal distension (P=0.018).

CONCLUSIONS

This is the first study to show that prolonged balloon expulsion time predicts abdominal distension in patients with bloating and constipation. Hence, ineffective evacuation of gas and stool associated with prolonged balloon expulsion may be an important mechanism underlying abdominal distension.

Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome

PURPOSE

Although functional constipation is known to often manifest concomitant features of pelvic floor dyssynergia, the nature of pelvic floor symptoms and anorectal dysfunction in non-diarrhea predominant irritable bowel syndrome is less clear. This study aims to compare anorectal sensorimotor function and symptoms of patients who have non-diarrhea predominant irritable bowel syndrome with those who have functional constipation.

METHODS

We studied 50 consecutive female patients referred with constipation and 2 or more symptoms of pelvic floor dyssynergia, who also satisfied Rome II criteria for either non-diarrhea predominant irritable bowel syndrome (n = 25; mean age, 47 +/- 3 y) or functional constipation (n = 25; 49 +/- 3 y). Assessments included the Rome II Integrative Questionnaire, a validated constipation questionnaire, Hospital Anxiety and Depression scale, visual analog scores for satisfaction with bowel habit and for impact on quality of life, and a comprehensive anorectal physiology study.

RESULTS

Both groups displayed physiological evidence of pelvic floor dyssynergia; but patients with non-diarrhea predominant irritable bowel syndrome exhibited a higher prevalence of abnormal balloon expulsion (P < .01) and less paradoxical anal contraction with strain (P = .045) than patients with functional constipation. These patients with irritable bowel syndrome also reported more straining to defecate (P = .04), a higher total constipation score (P = .02), lower stool frequency (P = .02), a trend toward harder stools (P = .06), and less satisfaction with bowel habit (P = .03) than patients with functional constipation.

CONCLUSION

Patients with non-diarrhea predominant irritable bowel syndrome with symptoms of pelvic floor dyssynergia exhibit overall pelvic floor dyssynergia physiology similar to that of patients with functional constipation. Certain features, however, such as abnormal balloon expulsion, may be more prominent in the patients with irritable bowel syndrome. Therapeutic modalities, such as biofeedback, that are effective in patients with functional constipation with pelvic floor dyssynergia should therefore be considered in selected patients with irritable bowel syndrome with pelvic floor dyssynergia.

Colorectal responses to distension and feeding in patients with spinal cord injury

The role of the central nervous system in enteroenteric motor reflexes remains controversial. Our aims were as follows: 1) to evaluate colorectal, rectocolic, gastrocolonic, and gastrorectal reflex responses in patients with cervical spinal cord injury (SCI) and 2) to compare these responses with those in healthy subjects. In six patients with SCI (5 male, 42 +/- 4 yr) and six healthy control subjects (5 male, 36 +/- 5 yr), 2-min phasic distensions were performed randomly via dual-barostat balloons in the colon and rectum. Continuous colonic and rectal balloon volumes were recorded during distensions and after a 1,000-kcal liquid meal. Mean balloon volumes were recorded before, during, and after phasic distensions and over 60 min postprandially. The colorectal response was similar in control subjects and SCI patients (rectal volume reduction = 28 +/- 11% and 15 +/- 5% in SCI patients and healthy subjects, respectively); the rectocolic response was variable. The gastrocolonic response was present in all subjects (colonic volume reduction = 49 +/- 4% and 44 +/- 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P < 0.0001) and a group effect in the second 30 min (P < 0.004). The gastrorectal response was present in four SCI patients and five healthy subjects (rectal volume reduction = 38 +/- 4% and 41 +/- 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P < 0.0001) but no group effect in the second 30 min. Intact neural transmission between the spinal cord and higher centers is not essential for normal colorectal motor responses to feeding and distension; however, a degree of central nervous system and neurohormonal modulation of these responses is likely.

Genetic variation in genes of the fatty acid synthesis pathway and breast cancer risk

Fatty acid synthase (FAS) is the major enzyme of lipogenesis. It catalyzes the NADPH-dependent condensation of acetyl-CoA and malonyl-CoA to produce palmitic acid. Transcription of the FAS gene is controlled synergistically by the transcription factors ChREBP (carbohydrate response element-binding protein), which is induced by glucose, and SREBP-1 (sterol response element-binding protein-1), which is stimulated by insulin through the PI3K/Akt signal transduction pathway. We investigated whether the genetic variability of the genes encoding for ChREBP, SREBP and FAS (respectively, MLXIPL, SREBF1 and FASN) is related to breast cancer risk and body-mass index (BMI) by studying 1,294 breast cancer cases and 2,452 controls from the European Prospective Investigation on Cancer (EPIC). We resequenced the FAS gene and combined information of SNPs found by resequencing and SNPs from public databases. Using a tagging approach and selecting 20 SNPs, we covered all the common genetic variation of these genes. In this study we were not able to find any statistically significant association between the SNPs in the FAS, ChREBP and SREPB-1 genes and an increased risk of breast cancer overall and by subgroups of age, menopausal status, hormone replacement therapy (HRT) use or BMI. On the other hand, we found that two SNPs in FASN were associated with BMI.

GPX1 Pro(198)Leu polymorphism, erythrocyte GPX activity, interaction with alcohol consumption and smoking, and risk of colorectal cancer

GPX1 encoding the enzyme glutathione peroxidase 1 (GPX1) and hOGG1 encoding the 8-oxoguanine glycosylase 1 (OGG1) may counteract oxidative stress and resulting DNA damage associated with lifestyle-related exposures. We examined whether the polymorphisms GPX1 Pro(198)Leu and OGG1 Ser(326)Cys or low erythrocyte GPX enzyme activity in pre-diagnostic blood samples are associated with colorectal cancer risk, and assessed possible interactions between the polymorphisms or enzyme activity and various lifestyle factors in relation to colorectal cancer risk. Additionally, we studied whether the GPX1 Pro(198)Leu polymorphism and several lifestyle factors predict GPX activity in erythrocytes. The present study was nested within the prospective "Diet, Cancer and Health" study of 57,053 Danes including 375 colorectal cancer cases and a comparison group of 779 individuals matched on gender. Biomaterial was sampled and information on lifestyle factors was obtained from questionnaires filled in at enrolment in 1993-1997. GPX1 Pro(198)Leu, hOGG1 Ser(326)Cys and erythrocyte GPX enzyme activity were not associated with risk of colorectal cancer. We observed a higher risk associated with alcohol consumption and smoking among homozygous GPX1(198)Leu carriers, with incidence rate ratios for colorectal cancer of 1.45 (95% CI: 1.17-1.81, P=0.02) per 10g alcohol intake per day and 2.56 (95% CI: 0.99-6.61, P=0.02) among ever smokers compared with never smokers at enrolment. Erythrocyte GPX activity was influenced by the GPX1 Pro(198)Leu genotype, gender, smoking intensity, and intake of fruits and vegetables. Our results indicate that lifestyle-related oxidative stress may be a risk factor for colorectal cancer among subjects with a lowered defence.

Social inequality and incidence of and survival from cancers of the oesophagus, stomach and pancreas in a population-based study in Denmark, 1994-2003

We investigated the effect of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the oesophagus, stomach and pancreas diagnosed during 1994-2003 with follow-up through 2006 in Denmark using information from nationwide registers. The analyses were based on data on 2075 patients with cancer of the oesophagus, 2673 with stomach cancer and 3657 with pancreatic cancer in a cohort of 3.22 million persons born between 1925 and 1973 and aged >or=30 years. Overall, we found decreasing incidence rates of all three gastrointestinal cancers with increasing social advantage; this was most pronounced for oesophageal cancer and least for pancreatic cancer. The effect of socioeconomic position on survival after these cancers was less clear, perhaps due to the poor relative survival from these cancers and the fact that all three cancers are relatively rare in Denmark.

Gene-environment interactions between smoking and a haplotype of RAI, ASE-1 and ERCC1 polymorphisms among women in relation to risk of lung cancer in a population-based study

Homozygous carriers of a haplotype consisting of ERCC1 Asn118Asn(A), ASE-1 G-21A(G), RAI IVS1 A4364G(A) are at increased risk of lung cancer especially among women. Here, we analyse for gene-environment interactions with the predefined haplotype in a case cohort study including 428 lung cancer cases and a comparison group of 800 persons, all from the prospective Diet, Cancer and Health cohort of 57,000 Danes. At high smoking intensity (>20g tobacco/day), there was only additional risk of smoking intensity among women who were homozygous carriers of the haplotype (IRR=2.03; 95% CI: 1.10-3.73 per 5 additional g tobacco/day).

XPA A23G, XPC Lys939Gln, XPD Lys751Gln and XPD Asp312Asn polymorphisms, interactions with smoking, alcohol and dietary factors, and risk of colorectal cancer

Polymorphisms in the XPD and the XPC gene have been associated with a lower DNA repair capacity. We determined the risk of colorectal cancer in association with the four polymorphisms XPA A23G, XPC Lys939Gln, XPD Lys751Gln and XPD Asp312Asn, and interactions between the polymorphisms and the environmental factors: smoking intensity, intake of alcohol, red meat, processed meat, fish and poultry, fruits and vegetables and dietary fibres, in relation to development of colorectal cancer in a study population of 405 colorectal cancer cases and a comparison group of 810 persons, nested within the Danish prospective cohort, Diet, Cancer and Health, of 57053 cohort members. No association was found between the XPC Lys939Gln, XPA A23G, XPD Lys751Gln, and XPD Asp312Asn polymorphisms and risk of colorectal cancer. The association of the XPD Lys751Gln polymorphism was statistically significantly different between genders, with a lower risk of colorectal cancer among women carrying the variant allele. We observed a statistically significant interaction between the XPC Lys939Gln polymorphism and consumption of red meat, with a 3.7-fold increase in colorectal cancer risk per 100g red meat intake per day among carriers of the homozygous variant, but virtually no effect of red meat intake among carriers of the wild type allele. In the light of the multiple comparisons being made, this result may be a chance finding. The results showed no interaction between the XPD Lys751Gln, XPA A23G, and XPD Asp312Asn polymorphisms and the environmental factors for the development of colorectal cancer. Overall, the results of the present study indicate that the four polymorphisms are not of major importance in colorectal cancer carcinogenesis.

Photopolymerized hydrogel carriers for live vaccine ballistic delivery

Photopolymerized poly(ethylene glycol) (PEG)-crosslinked hydrogels were assessed for their ability to serve as a payload vehicle to deliver a viable bacterial vaccine (Brucella abortus strain RB51 (RB51) to bison in Yellowstone National Park) ballistically using thermoplastic degradable Biobullets. PEG modified with degradable glycolide or lactide oligomers capped with photopolymerizable methacrylate groups served to crosslink the hydrogel vaccine carrier inside commercial hydroxypropylcellulose Biobullets. Release of 1 microm diameter model fluorescent particles from hydrogels followed known degradation trends for glycolide- and lactide-modified PEG hydrogels. All particles were released from PEG-co-glycolide hydrogels after approximately 10 days and PEG-co-lactide hydrogels after approximately 45 days following gel degradation. Minimal particle release was observed from pure PEG dimethacrylate hydrogels over 40 days. P. aeruginosa (strain PAO1) and RB51 live vaccines exhibit excellent viability following exposure to photopolymerization encapsulation within these gel matrices. Hydrogels photopolymerized into the payload chamber of Biobullets exhibit similar ballistic properties to commercially available Biobullets and penetrate and remain intact when fired intramuscularly into live elk for release of their gel payload in the host.

Esophageal dysmotility and acid sensitivity in patients with mitral valve prolapse and chest pain

Mitral valve prolapse (MVP) patients often experience non-cardiac chest pain. The aims of this study were to determine, in patients with non-cardiac chest pain: (i) whether esophageal dysmotility is more common in patients with MVP than in patients without MVP; and (ii) if acid sensitivity is an important cause of the chest pain in MVP patients. Esophageal manometry and acid perfusion testing were performed in 277 consecutive patients with non-cardiac chest pain. Patients with MVP (13 female, one male; mean age 49 years) were more likely (P = 0.01) to have esophageal dysmotility, while acid perfusion was less likely (P < 0.05) to provoke their chest pain, than in patients without MVP. The most common esophageal motor abnormalities detected in patients with and without MVP were diffuse esophageal spasm (prevalence, 57%) and non-specific motor disorder (prevalence, 9%), respectively. This study, the first large prospective series examining possible esophageal sensorimotor correlates of chest pain in MVP patients, demonstrates that in the absence of a cardiac cause for chest pain, a specific esophageal motility disorder should be excluded, rather than assuming the chest pain is likely to be due to acid sensitivity.

Body composition of Aboriginal Australian women: comparison with age-matched Caucasians

Although Aboriginal Australians (AA) exhibit an android fat deposition profile and suffer from a high incidence of type 2 diabetes, a comprehensive body composition assessment of AA has not yet been reported. The body composition of 16 non-diabetic AA women and 16 healthy age- and weight-matched Caucasian women (C) showed no significant ethnic differences in height, total body bone mineral density, total and appendicular skeletal muscle mass, and % fat. The abdominal fat-to-lean soft tissue ratio correlated more highly with age in AA ( r=0.79, p<0.001) than in C ( r=0.59, p<0.05) and with % fat in AA ( r=0.67, p<0.01) than in C ( r=0.54, p<0.05). However, analysis of variance showed that the difference between the two ethnic groups was not significant. Key findings are that dual-energy X-ray absorptiometry can accurately assess adiposity, and that hip girth should emerge as a valid predictor of central adiposity, in AA women.

Effects of 20-mg oestradiol implant therapy on bone mineral density, fat distribution and muscle mass in postmenopausal women

This 64-week prospective cohort trial evaluated the effects of 20-mg oestradiol implants, replaced every 4 months, in healthy postmenopausal women aged 45-65 years. Of 20 implant and 14 control subjects who remained in the trial at 32 weeks, 13 implant and seven controls continued to 64 weeks, with no baseline differences between completing and dropout subjects. At 64 weeks, implant subjects displayed increases of 5.4-7.6% in spine and hip bone mineral density ( p<0.05 versus controls). The abdominal fat-to-lean soft tissue ratio decreased by 18% in implant subjects ( p<0.001), but did not change in controls ( p<0.05 implants versus controls). Neither group displayed significant changes in weight, %fat or appendicular skeletal muscle mass. The 32-week data were consistent with these results. Hence, oestradiol implant therapy can reduce abdominal adiposity and could lower the risk of obesity-related metabolic disorders.

Plasma sample preparation by ultrafiltration for FTIR analysis

Total body water (TBW) may be significantly altered with disease. Isotope dilution techniques, considered to be the "gold standard" methods for measuring TBW, are expensive, time consuming and require considerable expertise, especially during the sample preparatory phase. In this study, a new method, ultrafiltration (UF), was hypothesised to be an efficient alternative to vacuum sublimation (VS) in the preparation of plasma samples for Fourier Transform Infra Red (FTIR) determination of TBW. Deuterium Oxide (D2O) concentrations were prepared in human plasma and subjected to both techniques. FTIR analysis was carried out on the resulting VS and UF solutions and on D2O concentrations in distilled water. The resulting absorbance values were then statistically compared. Urea concentrations prepared in D2O-containing plasma were also compared to "blank" plasma to investigate the effect of high plasma urea concentration on the resulting H2O/D2O mixture obtained during UF Paired t-tests showed that the VS plasma samples (p=0.003), but not the UF samples (p=0.9), were significantly different to D2O standards prepared in distilled water. While there was no evidence of an effect of urea on UF at low (0.4 g/L) D2O concentration, a marginal (p=0.04) effect occurred at a higher (1.6 g/L) D2O level. Throughput of samples was much more efficient with the UF technique. These findings indicate that the new UF method is an accurate, more efficient method of plasma sample preparation than the VS method in the FTIR determination of TBW.

Total body protein in chronic diseases and in aging

Substantial losses of total body protein (TBP) can occur in chronic diseases and in aging. Such losses impact negatively on immunity and quality of life, and on growth rates in children. Direct measurements of total body nitrogen (TBN) monitor the integrated changes in TBP over time and allow comparison with normal subjects. TBN assessment via neutron capture analysis is therefore the gold-standard method of TBP estimation, so that risk factors for protein deficit can be identified and patient management optimized. The nitrogen index (NI) can be used to predict prognostic outcome: an NI < 0.9 is associated with substantial wasting in HIV disease, an NI < 0.8 predicts significant pathophysiology in chronic renal failure, and a low NI is predictive of neutropenia in breast-cancer patients. These findings emphasize the central importance of adequate protein stores in recovery from disease or in maintaining quality of life. Aging appears to involve a gradual loss of TBP throughout adulthood. Cross-sectional data suggest that TBP declines curvilinearly with age, such that there is an accelerated decline after 65 years of age. However, longitudinal data are scarce, and little is known about the relative loss of visceral protein, as opposed to skeletal muscle protein. More clearly-defined data are essential if the effects of aging per se are to be separated from the effects of chronic disease. A further complication is the knowledge that physical activity also declines with age. Thus sarcopenia, the loss of skeletal muscle mass, could primarily result from disuse rather than aging. The economic impact of unsuccessful aging places a pressing need for multicompartment data in longitudinal study designs.

Determination of skeletal muscle and fat-free mass by nuclear and dual-energy x-ray absorptiometry methods in men and women aged 51-84 y (1-3)

BACKGROUND

Skeletal muscle mass (SMM) and fat-free mass (FFM) are important variables in nutritional studies. Accurate techniques for measuring these variables have not been thoroughly validated in elderly subjects.

OBJECTIVES

The objectives of this study were to 1) compare SMM values derived from dual-energy X-ray absorptiometry (DXA) with those calculated by a nuclear method from total body potassium (TBK) and total body nitrogen (TBN) measurement (both: KN) in older subjects, and 2) assess the accuracy of FFM measurement by DXA in these subjects.

DESIGN

TBK, TBN, DXA (model XR36; Norland, Fort Atkinson, WI), bioimpedance, and anthropometric measurements were performed on healthy women (n = 50) and men (n = 25) aged 51-84 y.

RESULTS

Mean SMM by KN was not significantly different from SMM by DXA in either sex. SMM by KN predicted SMM by DXA with an SEE of 2.1 kg (r = 0.95, P < 0.0001 for women and men together). In the men, FFM by DXA agreed well with FFM estimated by TBK, skinfold thicknesses, bioimpedance analysis, and a multicompartment model. In women, FFM by DXA was 4-5 kg less than that by the other methods (P < 0.01). Truncal fat was related to intermethod FFM differences (r = 0.58, P < 0.0001).

CONCLUSIONS

These data indicate that 1) either the nuclear or the DXA method can be applied to estimate SMM in healthy older subjects, and 2) the Norland DXA instrument significantly underestimates FFM in older women, in part, because of the influence of truncal adiposity.

Strategic planning: the basics and benefits

Strategic planning can help a medical practice take an honest look at itself in light of the changes taking place in its environment and within the practice itself. The objective is for the group to design a plan, or road map, to its envisioned future. For medical practices, strategic planning is a four part process: 1) gaining buy-in for the process itself from the leadership and physicians; 2) gathering pertinent data about the group's environment through external resources, and about the group itself through interviews and surveys of physicians; 3) conducting a facilitated off-site retreat of key physicians and leaders in order to review data, discuss issues and develop a one to two year action plan; and, 4) carrying out the action plan developed at the retreat and measuring its outcomes. A follow-up mini-retreat about six months after the first retreat is highly recommended, as is instituting a process of sharing of the results and outcomes of the plan with all members of the organization.

Murine in vivo total body nitrogen by photoactivation

A facility to measure total body nitrogen (TBN) by photoactivation analysis in rats, using the 14N(gamma, n)13N reaction, was designed, calibrated and evaluated. TBN provides a quantitative estimate of nutritional status. TBN in humans can be measured by neutron activation, however the small absolute amount of nitrogen in rats causes difficulties with this technique. Photoactivation analysis involved irradiating the specimen with high energy photons from an 18 MV Medical Linear Accelerator to a dose of approximately 2 Gy. The technique was calibrated using urea solution rat phantoms with 2.0-3.0% nitrogen content. By analysing the measured decay curve, the initial nitrogen count rate of 0.51 MeV photons was determined and the initial oxygen count rate, being an interfering source of 0.51 MeV photons, was shown to be constant. Within the range of nitrogen concentrations studied, the response is linear (r2 = 0.9) with a CV of 3.5%. Thus, photoactivation provides a relatively simple, in vivo technique for determining total body nitrogen in rats.

Detection of Staphylococcus aureus in milk by use of polymerase chain reaction analysis

OBJECTIVE

To evaluate polymerase chain reaction (PCR) analysis for detection of Staphylococcus aureus (nuc gene) in fresh and formalin-preserved milk.

SAMPLE POPULATION

Samples from 80 lactating sheep and 100 lactating dairy cows.

PROCEDURE

4 lactating sheep were inoculated with S aureus by intramammary infusion. A set of primers specific for the nuc gene of S aureus was used to develop a PCR technique, and modification of the rapid boil method was used to isolate bacterial DNA. Milk was obtained from experimentally infected sheep before and after infusion with S aureus, and from the 100 cows and remaining 76 sheep. Samples were screened by bacteriologic culture and PCR. To validate the PCR assay, S aureus or other pathogens were added to distilled water and "normal" sheep milk samples, with and without formalin.

RESULTS

The PCR assay was 100% specific for S aureus when known negative and positive samples were tested. Sensitivity was 100% for samples with added S aureus or other pathogens. Sensitivity was lower for samples obtained from experimentally infected sheep, but increased from 53% to 90% with increased washing of target DNA.

CONCLUSIONS

The PCR technique based on the nuc gene is able to detect S aureus in sheep milk yields results faster than does traditional culturing, is highly specific, and is able to detect S aureus in formalin-fixed milk samples.

CLINICAL RELEVANCE

The assay is particularly suitable for analysis of samples shipped or stored without refrigeration. Although antibiotics in milk may inhibit growth in culture, they should not affect the results of the PCR assay.

On the road with MGMA (Medical Group Management Association)

Preparing for the annual conference, members of the 1996 Annual Conference Committee traveled the country interviewing members. They discovered innovative work in rural and urban settings, multispecialty practice and physician-directed insurance companies. Richard Hansen presents his snapshots from the trip.

Calibration of a total body potassium monitor with an anthropomorphic phantom

An anthropomorphic phantom was used to calibrate a supine geometry sodium iodide total body potassium monitor. Correction factors accommodating variability in subject size were empirically determined. Measurements on 12 males of weight 45-96 kg, height 161-184 cm and 18 females of weight 48-89 kg, height 153-175 cm, showed that the 40K calibration factor (F, counts s-1 (g of potassium)-1) was significantly correlated (r = 0.88, p < 0.0001) to subject (weight/height)0.5, indicating comparable accuracy to 42K-based calibration procedures. Fat-free mass determined from the potassium measurements of 16 subjects correlated significantly with fat-free mass estimated from skinfold thickness (r = 0.98, p < 0.0001), dual-energy x-ray absorptiometry (r = 0.99, p < 0.0001) and bioimpedance analysis (r = 0.98, p < 0.0001). These data, together with the precision (coefficient of variation, CV = 1.5%) and accuracy (CV = 4.5%) of the system, indicate that this calibration procedure represents a relatively low-cost, non-invasive alternative to 42K-based methods of calibrating total body potassium monitors.

Infrared tympanic temperature as a predictor of rectal temperature in warm and hot conditions

BACKGROUND

Infrared (IR) thermometry has been proposed as a rapid, non-invasive means of monitoring core temperature. However, it has not been validated for use in warm to hot environments.

HYPOTHESIS

IR tympanic temperature (Tty) accurately predicts rectal temperature (Tre) during simulated marching in warm and hot conditions.

METHODS

Tty, and thermistor-derived Tre, aural canal (Tac) and cheek skin (T cheek) temperatures were monitored in seven males during 100 min of treadmill walking, in combat uniforms, at 5 km.h-1, slope 6%, in warm (30 degrees C, 60% RH) and hot (40 degrees C, 30% RH) conditions.

RESULTS

Tty was significantly different to Tre in hot, but not warm, conditions. Final Tty was 0.2 degrees C < Tre in warm, but 0.4 degrees C > Tre in hot, conditions. From 60-100 min of the warm trial, Tty predicted Tre with a standard error of estimate (SEE) of 0.15 degrees C (r = 0.9, p < 0.0001). In a multiple regression model, the combination of Tty, Tac, and Tcheek reduced this SEE to 0.1 degrees C. In the H trial, from 60-100 min Tty predicted Tre with a SEE of 0.21 degrees C (r = 0.7, p < 0.0001). Tty and Tac correlated significantly in both trials.

CONCLUSIONS

(1) the IR method should provide useful estimates of Tre in the field provided the influence of ambient conditions is taken into account; (2) the IR method is not as reliable as rectal monitoring in distinguishing accurately between degrees of heat strain; and (3) Tre prediction with the IR device may be improved in warm conditions if skin temperatures are combined with Tty.

Infrared thermometry in the diagnosis and treatment of heat exhaustion

Infrared (IR) thermometers (FirstTemp 2000A, Intelligent Medical Systems, California) were used to monitor tympanic temperature (Tty) in 12 collapsed fun-runners suspected of suffering exertion-induced heat exhaustion (EIHE). Rectal temperature (Tre) was monitored via digital clinical thermometers. Conditions during the fun-run and in the field treatment centre were cool (air temperature 16-18 degrees C, relative humidity 60-65%). On admission, Tty was (mean +/- SEM) 1.2 +/- 0.3 degrees C lower than Tre. For admission plus subsequent monitoring data pooled, although Tty correlated significantly with Tre (r = 0.86, p < 0.001), mean Tty (37.4 +/- 0.2 degrees C) was significantly lower (p < 0.01) than mean Tre (38.4 +/- 0.4 degrees C). Cotton wool ear pads, applied to 10 of the runners on admission to minimise environmental effects on Tty, did not significantly improve the IR monitoring. A Tty > or = 37.1 degrees C predicted a Tre > or = 38 degrees C (an established diagnostic criterion for EIHE) with a sensitivity of 0.93 and a specificity of 0.63. These data indicate that IR tympanic thermometry, when utilised in cool environments, can result in misdiagnosis of heat exhaustion. Although IR thermometry shows some promise as a rapid, non-invasive means of monitoring core temperature, it should not be used in the diagnosis and treatment of heat exhaustion unless further research validates the method.

Cultural, molecular, and immunological characterization of the etiologic agent for atypical canine ehrlichiosis

More than 100 cases of canine ehrlichiosis, with three fatalities, were serologically negative by the indirect immunofluorescent antibody (IFA) test with Ehrlichia canis or E. sennetsu antigen but were reactive at titers of 10 to 640 with E. risticii. Ehrlichia-like agents were isolated from three such cases. The agents isolated from those cases were morphologically indistinguishable from each other and from a prototype, E. risticii, the etiologic agent of equine monocytic ehrlichiosis, in terms of growth characteristics and by light or electron microscopy. The patterns of and products from PCR were identical to those of E. risticii. The 16S rRNA sequences were distinct from those of E. canis and E. ewingii but were identical to those of E. risticii. A PCR product corresponding to the 5' half of the 16S rRNA gene was obtained from amplification of DNA from E. risticii and both sources of the atypical canine ehrlichiosis agent but was not obtained from uninfected host cells. The entire sequence of 719 nucleotides was identical for all three sources. The percentages of relatedness of the partial 16S rRNA gene of the atypical canine ehrlichiosis agent to E. risticii, E. sennetsu, E. platys, E. equi, E. phagocytophila, E. canis, E. chaffeensis, and E. ewingii were 100.0, 98.9, 83.7, 83.0, 83.0, 82.2, 81.8, and 81.5, respectively. These data are consistent with the identity of these isolates as E. risticii. The caninotropic characteristics of naturally acquired infections due to E. risticii are herein described for the first time, and the epizootiological implications are discussed in relation to the host range of E. risticii, which may include dogs as reservoirs.

Repression at encoding: discrete appraisals of emotional stimuli

In previous research, the emotions associated with repressors' memorial representations were found to be more discrete than those associated with nonrepressors'. In each of the 3 experiments reported here, repressive discreteness was apparent in repressors' appraisals of emotional stimuli at the time they were encoded. In 1 experiment, Ss appraised individual facial expressions of emotion. Repressors judged the dominant emotions in these faces as no less intense than did nonrepressors, but they appraised the blend of nondominant emotions as less intense than did nonrepressors. In the remaining 2 experiments, Ss appraised crowds of emotional faces as well as crowds of geometric shapes. In both crowd experiments, the repressive discreteness was evident in appraisals of crowds of emotional faces but not in appraisals of crowds of geometric shapes. The repressive discreteness effect did not appear to reflect a general repressor-nonrepressor difference in the appraisal of stimulus features. Rather, the results suggested that repressive discreteness may be constrained to appraisals of emotions.

Serum haptoglobin concentration in swine naturally or experimentally infected with Actinobacillus pleuropneumoniae

Serum haptoglobin (Hp) concentrations were measured in swine that were naturally or experimentally infected with Actinobacillus pleuropneumoniae. In swine from a specific-pathogen-free herd, mean serum concentration of Hp (+/- SD) was 5.79 +/- 1.06 mg of cyanmethemoglobin-binding capacity (CHBC)/dl. Serum Hp concentrations in paired samples were measured at 7-day intervals in 40 swine randomly selected from a conventional herd that was experiencing an acute episode of pneumonia and deaths caused by A pleuropneumoniae serotype-5 infection. Day-0 and -7 serum Hp concentrations were 24.58 +/- 1.38 and 23.10 +/- 1.12 mg of CHBC/dl, respectively, with no significant difference between these measurements. In a second conventional herd with a history of chronic infection with A pleuropneumoniae serotype 5, serum concentrations of Hp measured in paired samples obtained 6 days apart were 12.36 +/- 0.81 and 18.63 +/- 0.76 mg of CHBC/dl, respectively, and were significantly (P < 0.05) different from each other. Twenty-nine 12-week-old conventional swine were challenged intranasally with A pleuropneumoniae serotype 1 (n = 19) and serotype 5 (n = 10). Serum Hp concentration increased from prechallenge concentrations of 7.49 +/- 1.38 and 15.10 +/- 1.22 mg of CHBC/dl, respectively, to 41.01 +/- 1.35 and 22.37 +/- 1.78 mg of CHBC/dl, respectively, 72 hours after challenge. For these 29 swine, serum Hp concentration was positively correlated with rectal temperature (r = 0.34; P < 0.001) during the immediate postchallenge period.

Repression at encoding: Discrete appraisals of emotional stimuli

In previous research, the emotions associated with repressors' memorial representations were found to be more discrete than those associated with nonrepressors'. In each of the 3 experiments reported here, repressive discreteness was apparent in repressors' appraisals of emotional stimuli at the time they were encoded. In 1 experiment, Ss appraised individual facial expressions of emotion. Repressors judged the dominant emotions in these faces as no less intense than did nonrepressors, but they appraised the blend of nondominant emotions as less intense than did nonrepressors. In the remaining 2 experiments, Ss appraised crowds of emotional faces as well as crowds of geometric shapes. In both crowd experiments, the repressive discreteness was evident in appraisals of crowds of emotional faces but not in appraisals of crowds of geometric shapes. The repressive discreteness effect did not appear to reflect a general repressor-nonrepressor difference in the appraisal of stimulus features. Rather, the results suggested that repressive discreteness may be constrained to appraisals of emotions.

Repression of emotionally tagged memories: the architecture of less complex emotions

We asked subjects to recall memories of events that evoked feelings of anger, sadness, fear, and embarrassment. These memories evoked patterns of dominant and nondominant emotions. The dominant emotions evoked by the recalled events were no less intense for repressors than nonrepressors, but repressors' patterns of nondominant emotions were less intense than those of nonrepressors. The data suggested that for repressors the associative network of negative emotional memories may be more discrete and less complex than that for nonrepressors. This finding was consistent with recent research indicating that negative emotional memories are less accessible for repressors than for nonrepressors. The pattern of multivariate effects suggests that this repressive memorial architecture may serve the motive of isolating fear-associated memories.

Finding the face in the crowd: an anger superiority effect

Facial gestures have been given an increasingly critical role in models of emotion. The biological significance of interindividual transmission of emotional signals is a pivotal assumption for placing the face in a central position in these models. This assumption invited a logical corollary, examined in this article: Face-processing should be highly efficient. Three experiments documented an asymmetry in the processing of emotionally discrepant faces embedded in crowds. The results suggested that threatening faces pop out of crowds, perhaps as a result of a preattentive, parallel search for signals of direct threat.

Repression of emotionally tagged memories: The architecture of less complex emotions

We asked subjects to recall memories of events that evoked feelings of anger, sadness, fear, and embarrassment. These memories evoked patterns of dominant and nondominant emotions. The dominant emotions evoked by the recalled events were no less intense for repressors than nonrepressors, but repressors' patterns of nondominant emotions were less intense than those of nonrepressors. The data suggested that for repressors the associative network of negative emotional memories may be more discrete and less complex than that for nonrepressors. This finding was consistent with recent research indicating that negative emotional memories are less accessible for repressors than for nonrepressors. The pattern of multivariate effects suggests that this repressive memorial architecture may serve the motive of isolating fear-associated memories.

Finding the face in the crowd: An anger superiority effect

Facial gestures have been given an increasingly critical role in models of emotion. The biological significance of interindividual transmission of emotional signals is a pivotal assumption for placing the face in a central position in these models. This assumption invited a logical corollary, examined in this article: Face-processing should be highly efficient. Three experiments documented an asymmetry in the processing of emotionally discrepant faces embedded in crowds. The results suggested that threatening faces pop out of crowds, perhaps as a result of a preattentive, parallel search for signals of direct threat.