Outer membrane c-type cytochromes required for Fe(III) and Mn(IV) oxide reduction in Geobacter sulfurreducens

The potential role of outer membrane proteins in electron transfer to insoluble Fe(III) oxides by Geobacter sulfurreducens was investigated because this organism is closely related to the Fe(III) oxide-reducing organisms that are predominant in many Fe(III)-reducing environments. Two of the most abundant proteins that were easily sheared from the outer surfaces of intact cells were c-type cytochromes. One, designated OmcS, has a molecular mass of ca. 50 kDa and is predicted to be an outer membrane hexaheme c-type cytochrome. Transcripts for omcS could be detected during growth on Fe(III) oxide, but not on soluble Fe(III) citrate. The omcS mRNA consisted primarily of a monocistronic transcript, and to a lesser extent, a longer transcript that also contained the downstream gene omcT, which is predicted to encode a second hexaheme outer membrane cytochrome with 62.6% amino acid sequence identity to OmcS. The other abundant c-type cytochrome sheared from the outer surface of G. sulfurreducens, designated OmcE, has a molecular mass of ca. 30 kDa and is predicted to be an outer membrane tetraheme c-type cytochrome. When either omcS or omcE was deleted, G. sulfurreducens could no longer reduce Fe(III) oxide but could still reduce soluble electron acceptors, including Fe(III) citrate. The mutants could reduce Fe(III) in Fe(III) oxide medium only if the Fe(III) chelator, nitrilotriacetic acid, or the electron shuttle, anthraquinone 2,6-disulfonate, was added. Expressing omcS or omcE in trans restored the capacity for Fe(III) oxide reduction. OmcT was not detected among the sheared proteins, and genetic studies indicated that G. sulfurreducens could not reduce Fe(III) oxide when omcT was expressed but OmcS was absent. In contrast, Fe(III) oxide was reduced when omcS was expressed in the absence of OmcT. These results suggest that OmcS and OmcE are involved in electron transfer to Fe(III) oxides in G. sulfurreducens. They also emphasize the importance of evaluating mechanisms for Fe(III) reduction with environmentally relevant Fe(III) oxide, rather than the more commonly utilized Fe(III) citrate, because additional electron transfer components are required for Fe(III) oxide reduction that are not required for Fe(III) citrate reduction.

Central nervous system abnormalities assessed with prenatal magnetic resonance imaging

OBJECTIVE

To determine the frequency at which magnetic resonance imaging (MRI) provides additional information in fetuses with suspected central nervous system (CNS) abnormalities on ultrasound.

METHODS

Between May 1, 1996, and March 26, 1999, 83 women with 90 fetuses (including seven sets of live twins) had 91 ultrasonographic and MRI examinations of the fetal CNS. Eight women were studied twice, one for two different indications. If referrals came from outside our institution, a confirmatory sonogram was obtained. Indications for examination were ventriculomegaly (n = 25), suspected neural tube defect (n = 16), arachnoid cyst (n = 12), large cisterna magna (n = 11), and miscellaneous indications (n = 20).

RESULTS

Magnetic resonance imaging findings led to changed diagnoses in 26 (40%) of 66 fetuses with abnormal confirmatory sonograms. Magnetic resonance imaging findings not found by ultrasound included partial or complete agenesis of the corpus callosum (n = 11), porencephaly (n = 6), hemorrhage (n = 5), tethered cord (n = 3), cortical gyral abnormality (n = 2), cortical cleft (n = 2), midbrain abnormality (n = 2), and partial or complete agenesis of the septi pellucidi (n = 3), as well as holoprosencephaly, cerebellar hypoplasia, subependymal and cortical tubers, vascular malformation, and vermian cysts (one case each). Abnormalities better delineated by MRI than ultrasound included three cephaloceles, a dural arteriovenous malformation, one distal sacral neural tube defect, and the mass effect of three arachnoid cysts. That information was used to alter patient counseling and at times management.

CONCLUSION

When a CNS anomaly is detected by sonography or suspected on ultrasound, MRI findings might lead to altered diagnosis and patient counseling.

Use of self-reported height and weight biases the body mass index-mortality association

BACKGROUND

Many large-scale epidemiological data sources used to evaluate the body mass index (BMI: kg/m(2)) mortality association have relied on BMI derived from self-reported height and weight. Although measured BMI (BMI(M)) and self-reported BMI (BMI(SR)) correlate highly, self-reports are systematically biased.

OBJECTIVE

To rigorously examine how self-reporting bias influences the association between BMI and mortality rate.

SUBJECTS

Samples representing the US non-institutionalized civilian population.

DESIGN AND METHODS

National Health and Nutrition Examination Survey data (NHANES II: 1976-80; NHANES III: 1988-94) contain BMI(M) and BMI(SR). We applied Cox regression to estimate mortality hazard ratios (HRs) for BMI(M) and BMI(SR) categories, respectively, and compared results. We similarly analyzed subgroups of ostensibly healthy never-smokers.

RESULTS

Misclassification by BMI(SR) among the underweight and obesity ranged from 30-40% despite high correlations between BMI(M) and BMI(SR) (r>0.9). The reporting bias was moderately correlated with BMI(M) (r>0.35), but not BMI(SR) (r<0.15). Analyses using BMI(SR) failed to detect six of eight significant mortality HRs detected by BMI(M). Significantly biased HRs were detected in the NHANES II full data set (χ(2)=12.49; P=0.01) and healthy subgroup (χ(2)=9.93; P=0.04), but not in the NHANES III full data set (χ(2)=5.63; P=0.23) or healthy subgroup (χ(2)=1.52; P=0.82).

CONCLUSIONS

BMI(SR) should not be treated as interchangeable with BMI(M) in BMI mortality analyses. Bias and inconsistency introduced by using BMI(SR) in place of BMI(M) in BMI mortality estimation and hypothesis tests may account for important discrepancies in published findings.

Impact of weight cycling on risk of morbidity and mortality

Unintentional weight gain is commonly observed in adult humans, often provoking intentional weight loss attempts followed by unintentional weight regain. This episodic variation in body weight over a period of time has been referred to as 'weight cycling'. Over the last two decades, weight cycling has been associated with a number of morbid health conditions and increased mortality. This article provides a comprehensive evaluation of recent weight-cycling evidence, looks to understand design differences between studies and study outcomes, assesses the need for further research on particular health outcomes, and proposes alternative methodologies that will bridge the needs and capabilities of research. Searches were conducted per PRISMA guidelines. Articles on weight cycling in the literature were initially identified using search strings in PubMed. Eligibility assessment of the remaining articles was performed independently by three reviewers to identify publications that presented direct evidence. Twenty human studies (in addition to seven animal studies) were selected and retained; 12 accounted for the intentionality of weight loss. Although weight regain following successful weight loss remains one of the most challenging aspects of body-weight regulation, evidence for an adverse effect of weight cycling appears sparse, if it exists at all.

Glutathione metabolism in newborns: evidence for glutathione deficiency in plasma, bronchoalveolar lavage fluid, and lymphocytes in prematures

Respiratory distress in premature newborns is associated with deficiency of surfactant in the bronchoalveolar lining fluid; this may be influenced by a local deficiency of antioxidants. Severe L-buthionine-S,R-sulfoximine-induced depletion of glutathione (GSH, a major antioxidant) in rodents is associated with lung type 2 cell lamellar body damage and decreased concentrations in lung and bronchoalveolar lavage fluid (BALF) of phosphatidyl choline (a major component of surfactant). At birth, prematurely born newborns (30-34 weeks) had lower peripheral venous plasma GSH concentrations than term (> 36 weeks) babies; these levels decreased further with increasing prematurity (< 27 weeks, with respiratory distress). On day 2, the peripheral venous plasma GSH concentrations reached a nadir, and the lowest levels were found in the most premature newborns. Lymphocyte GSH concentrations were lowest on day 2 and day 7, and in prematures (< 27 weeks, with respiratory distress) remained below adult lymphocyte GSH levels for at least 4 weeks. At birth, prematures (< 27 weeks, with respiratory distress) had a central plasma arterio-venous (A-V) GSH gradient across the lung (an estimate of lung uptake of GSH) of 0.72 +/- 0.15 (mean +/- SD) mumol/L; on day 2, the A-V gradient did not change significantly (0.49 +/- 0.09 mumol/L). At birth, these prematures had markedly decreased BALF GSH concentrations (compared with adult levels), and they were not significantly changed during the first 4 weeks of life. These results suggest that GSH deficiency is present in prematures and that it increases with the degree of prematurity. At birth, GSH deficiency will compromise the lungs' defense against oxidative stress injury. Oxidative stress is likely to increase if hyperoxic treatment is given for respiratory distress in these infants.

Assessing the Validity and Responsiveness of Disease-specific Quality of Life Instruments in Intermittent Claudication

PURPOSE

To recommend a suitable disease-specific quality of life (QOL) instrument for use in intermittent claudication (IC) based on validity and responsiveness.

METHODS

Seventy claudicants completed two generic (SF36 and EUROQOL) and three disease-specific (CLAUS, VASCUQOL and SIP(IC)) QOL instruments prior to and 6 months after treatment (angioplasty or conservative therapy). Ankle brachial pressure indices and treadmill walking distances were measured at each assessment and International Society of Cardiovascular Surgery (ISCVS) recommended outcome measures were used to stratify the results. Construct and convergent-divergent validity was assessed for the three disease-specific QOL instruments. Responsiveness was assessed using effect sizes (effect size >0.5 is clinically significant).

RESULTS

All clinical indicators improved significantly following treatment. All five domains of CLAUS, the VASCUQOL and SIP(IC) showed highly significant spearman correlation with intermittent claudication distance (ICD) and maximum walking distance (MWD) (0.267-0.697, p=0.01), suggesting good construct validity. There was greater correlation between like domains of CLAUS and SF36 than non-like domains suggesting good convergent-divergent validity. Pain domain of CLAUS and VASCUQOL could detect mild clinical improvement significantly (effect sizes 0.55 and 0.67). Pain and everyday life domain of CLAUS and the VASCUQOL could detect moderate clinical improvement significantly (effect sizes 0.7, 0.74 and 0.56, respectively).

CONCLUSION

The three disease-specific QOL instruments (CLAUS, VASCUQOL, SIP(IC)) showed a high degree of construct and convergent-divergent validity. Amongst the three disease-specific QOL instruments, the VASCUQOL was most responsive and we would recommend its use in clinical practice.

A comparative study of aortic wall stress using finite element analysis for ruptured and non-ruptured abdominal aortic aneurysms

BACKGROUND

The decision to repair an asymptomatic abdominal aortic aneurysm (AAA) is currently based on diameter (> or =5.5 cm) alone. However, aneurysms less than 5.5 cm do rupture while some reach greater than 5.5 cm without rupturing. Hence the need to predict the risk of rupture on an individual patient basis is important. This study aims to calculate and compare wall stress in ruptured and non-ruptured AAA.

METHODS

The 3D geometries of AAA were derived from CT scans of 27 patients (12 ruptured and 15 non-ruptured). AAA geometry, systolic blood pressure and literature derived material properties, were utilised to calculate wall stress for individual AAA using finite element analysis.

RESULTS

Peak wall stress was significantly higher in the ruptured AAA (mean 1.02 MPa) than the non-ruptured AAA (mean 0.62 MPa). In patients with an identifiable site of rupture on CT scan, the area of peak wall stress correlated with rupture site.

CONCLUSIONS

Peak wall stress can be calculated from routinely performed CT scans and may be a better predictor of risk of rupture than AAA diameter on an individual patient basis.

Ascorbic acid prevents oxidative stress in glutathione-deficient mice: effects on lung type 2 cell lamellar bodies, lung surfactant, and skeletal muscle

Glutathione deficiency in adult mice leads to lung type 2 cell lamellar body and mitochondrial damage; as reported here, these effects are associated with marked decrease of the levels of phosphatidylcholine (the main component of lung surfactant) in the lung and the bronchoalveolar lining fluid. Severe mitochondrial damage was also found in skeletal muscle. Treatment with ascorbate (1-2 mmol per kg of body weight per day), which led to greatly increased (approximately 2-fold) levels of lung and muscle mitochondrial glutathione, prevented damage to lamellar bodies and mitochondria as well as the decline of phosphatidylcholine levels in lung and alveolar lining fluid. The findings indicate that glutathione deficiency leads to depletion of lung surfactant and that this can be prevented with ascorbate. Administration of ascorbate spares glutathione and prevents cellular damage. Lamellar body degeneration in glutathione deficiency appears to be associated with oxidative damage to the perilamellar membrane, which contains the enzymes required for phosphatidylcholine synthesis. It is notable that although severe glutathione deficiency is lethal to newborn rats, which apparently do not synthesize ascorbate, adult mice are better able to survive such a deficiency because they can synthesize ascorbate. The present studies, which suggest that high doses of ascorbate may be of therapeutic value, emphasize that ascorbate and glutathione have actions in common and that they function together in a physiologically significant antioxidant system.

Disease-specific quality of life assessment in intermittent claudication: review

OBJECTIVES

intermittent claudication (IC) is a common condition that has a major impact on the patients' quality of life (QoL). Generic QoL instruments often lack sensitivity to detect small but clinically significant variation in QoL. Disease-specific instruments may overcome this problem. This study aims to review various disease-specific QoL instruments available for use in IC and make recommendations for clinical utilization based on validity, reliability and responsiveness.

METHODS

a detailed literature search and extensive bibliography review of all papers relating to disease-specific QoL and IC.

RESULTS

several disease-specific QoL instruments are available for use in patients with IC. The most notable of these are the Claudication Scale (CLAU-S), Sickness Impact Profile - Intermittent Claudication (SIP(IC)) and the VascuQoL. The Walking Impairment Questionnaire (WIQ) is an objective measure of the patient's walking ability and not a QoL instrument.

CONCLUSION

many of the questionnaires are new and have undergone only a limited validation process. More work is required in this field before any one disease-specific QoL instrument can be recommended for use in patients with IC.

Development and roll out of the JETS e-portfolio: a web based electronic portfolio for endoscopists

The JAG Endoscopy Training System (JETS) e-portfolio was designed to provide an electronic log of endoscopic experience, improve the effectiveness of training, streamline the JAG certification process and support the quality assurance of trainers, units and regional training programmes. It was piloted in 2008 with an 82.6% uptake in trainees offered the system. The system was released in the UK in September 2009. Steady adoption across the UK demonstrates the service finds it a valuable tool. In time it will be the only vehicle through which a trainee can achieve certification through JAG to practise independently.

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke

BACKGROUND AND PURPOSE

The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear.

MATERIALS AND METHODS

In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery.

RESULTS

Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58-79 years). A van Swieten score of 3-4 (n = 74/389, 19%) was associated with a higher rate of 90-day mRS of 3-6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34-5.93; P = .008). Although the death rate was higher in patients with van Swieten scores of 3-4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56-2.26; P = .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93-4.84; P < .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed.

CONCLUSIONS

Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease.

A Non-randomised Controlled Trial of the Clinical and Cost Effectiveness of a Supervised Exercise Programme for Claudication

OBJECTIVES

The main aims of treatment in patients with intermittent claudication (IC) are to improve the clinical indicators of lower limb ischaemia and patients' quality of life (QoL). The aims of this study were assess the clinical and cost effectiveness of a supervised exercise programme (SEP) in patients with IC.

DESIGN

Non-randomised, controlled trial.

SETTING

University teaching hospital.

PATIENTS AND METHODS

Two groups of patients with IC were studied. Seventy patients were sequentially recruited before and after the establishment of a Supervised Exercise Programme at our unit. Thirty-seven patients (median age 69 years, 26 men) received conservative medical therapy (CMT) and 33 patients (median age 67 years, 22 men) received CMT plus a 3 month SEP of graduated physical exercise for sixty minutes, three times each week. Patients were assessed prior to and at 6 months following treatment. At each assessment patient reported walking distances (PRWD), treadmill claudication and maximal distances (ICD and MWD), ankle brachial pressure indices (ABPI) pre & post exercise and patient reported QoL using the SF36 questionnaire were assessed.

RESULTS

Prior to intervention the two groups were well matched. Following treatment, CMT patients demonstrated no significant change in PRWD or ICD but did record a small but significant improvement in MWD. CMT was also associated with a negative effect size in the SF36 index and in 7 of the 8 SF36 QoL domains, effect size >-0.5 for the domains of Physical Function and Emotional Role. SEP patients demonstrated significant improvement in PRWD, ICD and MWD. SEP was associated with a positive effect size in the SF36 index and in 2 SF36 QoL domains but a negative effect size in a further 2 domains. However, all QoL effect sizes following SEP were < +/-0.5. Intergroup differences in effect sizes were >0.5 for the SF36 domains of Physical Function, Physical Role, Emotion Role and SF36 index. SEP resulted in a 0.027 quality adjusted life year (QALY) gain over CMT in the first year post-treatment thus the cost/QALY gained of SEP is pound1780 at 1 year.

CONCLUSIONS

Compared to CMT, SEP increases walking distances, improves QoL and is a highly cost-effective treatment for IC.

Reduction of DMH-induced colon tumors in rats fed psyllium husk or cellulose

The effect of feeding psyllium husk, a water-soluble fiber, and cellulose, a water-insoluble fiber, against chemically induced colon cancer was investigated in rats. Adult male rats were fed semipurified diets containing 20% fat, no fiber, or 10% psyllium husk or cellulose for 22 weeks. Tumors were induced in one-half of the rats fed each diet by the gastric intubation of 1,2-dimethylhydrazine (DMH) during Weeks 3-11. In terms of the number of animals with tumors in each group, psyllium strongly reduced the tumorigenicity of DMH and cellulose moderately reduced tumorigenicity, whereas the two fibers did not differ significantly from each other with respect to tumorigenicity. Psyllium-fed rats had the highest fecal aerobic counts, lowest beta-glucuronidase, and highest 7-alpha-dehydroxylase activities. The psyllium diet also resulted in increased fecal output and percent moisture. Rats fed cellulose tended to have greater fecal bulk and lower beta-glucuronidase activity compared with rats fed no fiber and lower 7-alpha-dehydroxylase activity compared with rats fed psyllium husk.

Psyllium husk. II: Effect on the metabolism of apolipoprotein B in African green monkeys

Dietary psyllium's ability to reduce low-density-lipoprotein (LDL) cholesterol is presumably mediated by increased LDL catabolism and/or reduced LDL synthesis. To distinguish between these possibilities, apolipoprotein B (apo B) metabolism was studied in adult male African green monkeys consuming one of three semipurified diets: low-cholesterol cellulose (LCC), high-cholesterol cellulose (HCC), or high-cholesterol psyllium (HCP). 131I-labeled LDL and 125I-labeled VLDL were injected simultaneously into animals; blood samples were drawn at selected times and apo B specific activity determined in VLDL, IDL, and LDL. Based on a multicompartmental model, LDL apo B pool size and de novo apo B transport were elevated significantly in HCC animals compared with HCP and LCC animals. Differences in LDL transport, although not significant, paralleled differences observed in LDL apo B pool size. Fractional catabolic rates were similar among groups (HCC 0.040 +/- 0.010; HCP 0.042 +/- 0.009, and LCC 0.043 +/- 0.004 pools/h). These data suggest that dietary psyllium reduces plasma cholesterol concentrations by decreasing LDL synthesis.

Body mass index and mortality rate among Hispanic adults: a pooled analysis of multiple epidemiologic data sets

OBJECTIVE

To evaluate the association between body mass index (BMI, kg m⁻²) and mortality rate among Hispanic adults.

METHODS AND PROCEDURES

Analysis of five data sets (total N=16,798) identified after searching for publicly available, prospective cohort data sets containing relevant information for at least 500 Hispanic respondents (≥18 years at baseline), at least 5 years of mortality follow-up, and measured height and weight. Data sets included the third National Health and Nutrition Examination Survey, the Puerto Rico Heart Health Program (PRHHP), the Hispanic Established Population for Epidemiologic Studies of the Elderly (HEPESE), the San Antonio Heart Study (SAHS) and the Sacramento Area Latino Study on Aging.

RESULTS

Cox proportional hazards regression models, adjusting for sex and smoking, were fit within three attained-age strata (18 to younger than 60 years, 60 to younger than 70 years, and 70 years and older). We found that underweight was associated with elevated mortality rate for all age groups in the PRHHP (hazard ratios [HRs]=1.38-1.60) and the SAHS (HRs=1.88-2.51). Overweight (HRs=0.38 and 0.84) and obesity grade 2-3 (HRs=0.75 and 0.60) associated with reduced mortality rate in the HEPESE dataset for those in the 60 to younger than 70 years, and 70 years and older attained-age strata. Weighted estimates combining the HRs across the data sets revealed a similar pattern.

CONCLUSION

Among Hispanic adults, there was no clear evidence that overweight and obesity associate with elevated mortality rate.

Psyllium husk. I: Effect on plasma lipoproteins, cholesterol metabolism, and atherosclerosis in African green monkeys

Psyllium's effects on plasma and lipoprotein cholesterol concentrations, cholesterol metabolism, and diet-induced atherosclerosis were studied in adult male African green monkeys (Cercopithecus aethiops). Animals were fed for 3.5 y one of three experimental diets: low-cholesterol cellulose (LCC), high-cholesterol cellulose (HCC), or high-cholesterol psyllium (HCP). The LCC and HCP groups had significantly (P less than 0.05) lower plasma cholesterol concentrations (39% lower) at 1 mo than did the HCC group. These responses persisted throughout the study. Plasma cholesterol changes were due to a reduction in intermediate-density and low-density lipoproteins; very-low and high-density-lipoprotein concentrations were similar among groups. Aortic atherosclerosis, evaluated as percent sudanophilia at 3.5 y, was lowest in the LCC group, intermediate in the HCP group, and highest in the HCC group. Cholesterol absorption, neutral steroid and fat excretion, HMGCoA reductase activity (in intestine and liver), and body weight were unrelated to psyllium's hypocholesterolemic effects.

Light wine consumption is associated with a lower odd for cardiovascular disease in chronic kidney disease

AIMS

To examine the association between wine consumption and the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD).

DATA SYNTHESIS

We performed a cross-sectional logistic regression analysis of National Health and Nutrition Examination Survey (NHANES) in participants 21 years of age or older from 2003 to 2006 in a large representative study of the U.S.

POPULATION

Wine consumption was categorized as none (0 glass per day), light (<1 glass per day), or moderate (≥1 glasses per day). Prevalent CKD was defined as a urine albumin/creatinine ratio (UACR) ≥30 mg/g or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². CVD was defined as history of CVD including angina, myocardial infarction, or stroke. Only 27 (0.5%) individuals reported moderate wine consumption, whereas 57.5% and 42% reported abstinence and light wine consumption, respectively. Light wine consumption was associated with a lower prevalence of CKD as opposed to abstinence in unadjusted analysis. After adjusting for demographics and CVD risk factors light wine consumption was associated with lower prevalence of CKD defined as UACR ≥30 mg/g but not with low eGFR. Furthermore, light wine consumption was associated with significantly lower rates of CVD in the general population and in subjects with CKD. The adjusted odd of CVD for those with light wine consumption was 0.72 (CI 0.52-0.99, p = 0.046) for the subjects with CKD.

CONCLUSION

These data suggest that light wine consumption (compared to abstinence) is associated with lower prevalence of CKD and a lower odd of CVD in those with CKD in the U.S.

Effects of dietary cellulose, psyllium husk and cholesterol level on fecal and colonic microbial metabolism in monkeys

The effect of long-term feeding of dietary fiber and two levels of cholesterol on monkey colonic microbial metabolism was studied. Three groups of African green monkeys were fed for 3.5 yr purified diets containing 9.7% cellulose or psyllium husk and 0.8 mg cholesterol per kcal or 9.7% cellulose and 0.1 mg cholesterol per kcal. Total viable anaerobe and aerobe counts, microbial beta-glucuronidase activity, volatile fatty acid and ammonia nitrogen concentrations, dry matter and pH were determined in fecal and colonic samples. Compared to cellulose, psyllium husk feeding decreased (P less than 0.05) percentage dry matter, beta-glucuronidase (EC 3.2.1.31) activity and pH, and increased (P less than 0.05) ammonia nitrogen and volatile fatty acid output in feces and in colon contents. In all groups, colonic beta-glucuronidase activity was greater (P less than 0.05) than in fecal samples. Microbial beta-glucuronidase activity, pH or percentage dry matter in the ascending colon was not different from that in the transcending or descending segments. The ratio of anaerobic to aerobic bacteria was lower in colon contents from monkeys fed psyllium husk compared to those fed cellulose. Total viable bacterial counts were lower in monkeys fed low cholesterol compared to high cholesterol diets. The results suggest that chronic intake of dietary psyllium husk resulted in greater colonic microbial metabolism compared to cellulose feeding.

The Value of Abdominal Examination in the Diagnosis of Abdominal Aortic Aneurysm

BACKGROUND

There is considerable variability in the reported value of clinical examination in the diagnosis of abdominal aortic aneurysms (AAA). This study aims to assess accuracy of abdominal examination by a doctor, a nurse and the patient in the diagnosis of AAA and whether this accuracy is related to the size of the aneurysm and/or the BMI of the patient.

METHODS

164 patients, 138 men and 26 women, median age 71 years, consented to participate in this prospective, single blind, controlled study. Thirty-nine patients attending for carotid duplex were used as controls. Abdominal examination was performed by a doctor and a nurse. Patients then performed self-examination.

RESULTS

Examination by a doctor, a nurse and the patient were similar in accuracy in diagnosing/excluding AAA which was directly related to AAA size and patient BMI. The Negative Predicted Value of abdominal examination exceeds 0.9 with AAA diameters > or =4 cm and the Positive Predictive Value exceeds 0.8 with AAA diameters > or =5 cm.

CONCLUSIONS

Abdominal examination by a doctor, a nurse and the patient is of value in the exclusion and diagnosis of significant AAA. It should be promoted and may represent a useful adjunct to population screening with ultrasound.