bluuebunny/crossref_metadata_2025 huggingface dataset:
The assessment of atherosclerosis on vascular structures in patients with acute coronary syndrome
Authors: Kalay Nihat , Yarlioglues Mikail , Ardic Idris , Duran Mustafa , Kaya Mehmet Gungor , Inanc Tugrul , Dogan Ali , Koç Fatih , Çiçek Davran , Kasapkara Ahmet , Çelik Ahmet , Topsakal Ramazan , Oguzhan Abdurrahman , Ergin Ali
Published: May 2017

Introduction: Endothelial dysfunction plays a crucial role in the process of atherosclerotic diseases and has been accepted as an early stage of atherosclerosis. Carotid intima-media-thickness (CIMT) and flow-mediated-dilatation (FMD) of the brachial artery have been recommended as noninvasive methods to assess endothelial structure and function. Angiographic properties of patients with acute coronary syndrome (ACS) are closely associated with cardiovascular events. In this study, we investigated the relation of atherosclerotic properties of coronary, brachial and carotid arteries with CIMT, FMD and coronary angiography in patients with ACS.

Methods: We enrolled 133 patients who were diagnosed with ACS into this study. Exclusion criteria were known coronary artery disease, diabetes mellitus and hypertension. Coronary angiography, CIMT and FMD were measured in all patients. The numbers of major stenotic coronary vessels with ?50% or ?70% were defined as diseased vessel. Gensini score was used to evaluate the severity of atherosclerosis. Morphologic properties of stenotic lesion were defined. Cutoff levels were 7% for FMD and 0.9 mm for CIMT.

Results: Mean age was 59.7±11.8 years. FMD, CIMT and Gensini score were 8.3±5.9%, 0.80±0.19 mm and 7.8±3.5, respectively. Only 44% of patients with ACS had impaired FMD. Gensini score, number of diseased vessels and number of critical lesions were higher in patients with impaired FMD. (Gensini: 8.7±3.6 vs. 7.0±3.1, p=0.009, diseased vessels: 2.7±0.4 vs. 2.3±0.7, p < 0.0001, critical lesions: 3.0±2.1 vs. 2.2±1.4, p=0.02). Increased CIMT was found in only 33% of patients. Gensini score and number of diseased vessels were significantly higher in patients with increased CIMT. Significant but weak correlations were found between CIMT, FMD and angiographic severity of coronary atherosclerosis. Angiographic properties and lesion morphology were similar between CIMT and FMD groups.

Conclusion: There appears to be a relationship between CIMT, FMD and severity of coronary atherosclerosis in patients with ACS. However, in patients with ACS, morphologic properties of stenotic lesions are not associated with CIMT and FMD in brachial artery.
Comparison of two oscillometric blood pressure monitors in subjects with atrial fibrillation
Authors: Lamb Tyler S , Thakrar Amar , Ghosh Mahua , Wilson Merne P , Wilson Thomas W
Published: May 2017

Objective: To compare blood pressure readings obtained with two commonly used oscillometric monitors: Omron HEM 711 AC (OM) and Welch-Allyn 52000 series NIBP/oximeter (WA) with mercury sphygmomanometers (Merc) in subjects with atrial fibrillation.

Methods: We recruited 51 hemodynamically stable subjects with atrial fibrillation. Fifty four subjects in normal sinus rhythm served as controls. Supine blood pressure readings in each arm were recorded simultaneously using one monitor and Merc. The second monitor then replaced the first and readings were repeated. Merc was then switched to the opposite arm, and both monitors retested. Apical heart rates were ascertained with a stethoscope. We used the averaged, same arm Merc readings as “gold standard”.

Results: Automated blood pressure readings were obtained in all control subjects and in all but three of those with atrial fibrillation. Both monitors, and operators, noted a difference between apical and radial/brachial pulse rates: apical-recorded: Merc 6.1±15.0; OM 5.5±13.7; WA 10.0±21.2 beats per minute. Both monitors were accurate in controls: over 90% of readings were within 10 mmHg of averaged Merc, and both achieved European Hypertension Society standards. In subjects with atrial fibrillation, about one quarter of all oscillometric readings differed from Merc by more than 10 mmHg. Both falsely high and falsely low readings occurred, some up to 30 mmHg. There was no relation between accuracy and heart rate.

Conclusions: Single blood pressure readings, taken with oscillometric monitors in subjects with atrial fibrillation differ, often markedly, from those taken manually. Health care professionals should record multiple readings manually, using validated instruments when making therapeutic decisions.
Dietary fiber alleviates intestinal barrier dysfunction in post-trauma rats
Authors: Hou Huichi , Ping Xiaochun , Zhu Yanfei , Zhao Zengshun , Li Yousheng , Li Jieshou
Published: May 2017

Background: Damage to the intestinal barrier often occurs following severe trauma. It has been reported that enteral nutrition with dietary fiber (DF) could mitigate impairment of the intestinal barrier and might therefore be effective in clinical application; however, the conclusions from existing trials are controversial and the nature of the protective mechanism is far from clear. This study investigated the protective mechanism of dietary fiber on intestinal barrier in rats under bilateral closed femur fracture.

Methods: Twenty-four Sprague-Dawley rats were divided into four groups: normal control without any manipulation, trauma control with normal feeding, DF and dietary fiber-free (NF) groups fed with Nutrison Fibre and Nutrison, respectively. The later two groups were further divided into 1, 4, 7 and 10 days post-trauma groups.

Results: The trauma caused body weight decline, promoted bacterial translocation, and decreased immune function. The levels of portal vein endoxin in DF group was significantly lower than in NF group (p=0.013). Levers of both serum TNF-α and IL-6 on post-trauma day 10 showed no statistical differences between DF and NF groups. The incidence of bacterial translocation recovered to normal in DF group. Only secreted immunoglobulin a (sIgA) levels in DF group was higher than in NF group (p=0.005).

Conclusion: Early enteral nutrition with dietary fiber could alleviate damage to intestinal barrier function and decreased the incidence of bacterial translocation caused by trauma and endotoxemia in rats under extra-abdominal trauma.
Relationship between elevated platelet volume and saphenous vein graft disease
Authors: Tavil Yusuf , Şen Nihat , Yazici Hüseyin Uğur , Hizal Fatma , Açikgöz Sadik Kadri , Turfan Murat , Çengel Atiye
Published: May 2017

Background: Saphenous vein graft (SVG) disease is the major determinant of long term graft viability in patients undergoing coronary artery bypass graft (CABG) surgery. Although, platelets play a major role in this pathogenetic process the nature of this interaction has not been yet been clarified. Mean platelet volume (MPV) reflects platelet production rate and stimulation. This study was designed to investigate MPV in patients with late stage SVG disease.

Methods: The study population composed of 188 patients who underwent elective coronary angiography more than one year after coronary artery bypass surgery. The study population was divided in to two groups according to SVG patency. The first group consisted of 90 patients (75 men, 15 women; mean age, 63.4 ± 9.2 years) with patent SVG’s (no-stenosis group). The second group consisted of 98 patients (80 men, 18 women; mean age, 62.1 ± 10.1 years) with SVG stenosis based on the results of coronary angiography (stenosis group). Gretaer than 50% stenosis within the SVG was accepted as hemodynamically significant.

Results: MPV were significantly higher in patients with SVG disease in comparison with the patients without graft disease group (9.3 ± 1.19 vs. 8.3 ± 1.10 fl, respectively, p < 0.001). In a multiple regression model, SVG disease was independently associated with MPV (β=0.837, p=0.05) along with LDL-cholesterol (β=0.159, p=0.008) and time interval after bypass surgery (β=-0.092, p=0.05).

Conclusion: Platelet volume, and therefore platelet activation, appears to play a causal role in late SVG disease graft disease; hence, MPV may be useful as a post-operative marker of graft success.
FK506 treatment in a Long-term chronic rejection rat model of small bowel transplantation
Authors: Zhu Yanfei , Wei Wei , Li Yousheng
Published: May 2017

Background: Although acute rejection (AR) can be significantly improved by effective immunosuppressants, such as FK506, chronic rejection (CR) remains a major hurdle to long-term allograft survival after small bowel transplantation, in part because the pathogenic mechanisms of CR are, as yet, unknown. The rat orthotopic small bowel transplantation (OSBT) model has been used by a few researchers, but without long-term survival.

Methods: Rats were randomly divided into five groups: Group 1 (n=20), sham-operation rats; Group 2 (n=20), Lewis to Lewis; Group 3 (n=20), F344 to Lewis treated with FK506 (0.3 mg/kg/day); Group 4 (n=20), F344 to Lewis with FK506 (0.5 mg/kg/day); Group 5 (n=20), F344 to Lewis with FK506 (1.0 mg/kg/day). FK506 was administrated intramuscularly to recipients on postoperative days (POD) 0-13, 20 and 27. Body weight, survival rate and histology were measured.

Results: Histopathological analysis revealed distinctive abnormalities of the allograft for all animals, including changes in villous architecture, interstitial fibrosis and intimal thickening; however, survival times were significantly increased with higher doses of FK506. Rats in Group 3 and Group 4 (low and moderate FK506 doses) survived 16-18 weeks, while recipients in Group 5 (high dose) survived 24-27 weeks.

Conclusion: FK506 treatment (1.0 mg/kg/day, intramuscularly administrated to recipients on POD0-13, 20 and 27) can be used effectively to establish a rat OBST model of CR that will be useful for the study of the pathogenesis of CR and the effectiveness of various drugs.
Treatment of ischemic limbs by transplantation of G-CSF stimulated bone marrow cells in diabetic rabbits
Authors: Meng Jianbo , Yao Xiaoguang , Kang Shengqun , Kang Suxian , Yang Yan , Zhou Chenguang
Published: May 2017

Purpose: To evaluate the efficacy of autologous transplantation of granulocyte colony-stimulating factor (G-CSF) stimulated bone marrow mononuclear cells in the treatment of diabetic lower limb ischemic disease in a rabbit model.

Methods: The diabetic model was produced by intravenous injection of 5% alloxan into New Zealand white rabbits. The lower limb ischemia model was created by femoral artery ligation in diabetic rabbits (n=50) 14 days after alloxan injection. Animals were then randomized into five groups (10 rabbits per group): group 1, transplanted with G-CSF immobilized peripheral blood mononuclear cells (PBMNC); group 2, transplanted with G-CSF stimulated bone marrow mononuclear cells (BMMNC); group 3, animals were transplanted with non-stimulated BMMNCs; group 4, G-CSF group injected with G-CSF alone without transplantation; and group 5, PBS group treated with PBS alone. Necrosis of foot or toes and blood flow recovery in ischemic limbs was assessed. Expression of von Willebrand factor (vWF) and vascular endothelial cell growth factor (VEGF) were measured in ischemic muscles by immunohistochemistry analysis.

Results: Blood flow in ischemic limbs was significantly improved in the G-BMMNC group (ratio of blood flows: 0.82±0.06) in comparison with the G-PBMNC (0.61±0.09) and BMMNC (0.62±0.08) groups (P < 0.001). In the G-BMMNC group, the capillary density, a measure of vWF expression, was significantly higher than in either the G-PBMNC or BMMNC groups (47.9±2.51 vs. 36.8±4.16 and 39.6±2.72, respectively, P < 0.05). The expression of VEGF in G-BMMNC animals was significantly increased in comparison with the G-PBMNC and BMMNC groups (16.93±0.70 vs. 11.83±0.98 and 12.32±0.96, respectively, P < 0.05).

Conclusion: A combination of G-CSF stimulation and autologous transplantation of bone marrow stem cells synergistically improved neovascularization and angiogenesis in ischemic limb tissues in diabetic rabbits.
Glucocorticoid receptor expression and glucocorticoid therapeutic effect in nasal polyps
Authors: Li Peng , Li Yuan , Li Yong-Qi , Yang Qin-Tai , Zhang Ge-Hua
Published: May 2017

Purpose: To investigate the expression and quantity of glucocorticoid receptor-α and -β in polyp tissues taken from the patients treated were subsequently treated with topical glucocorticoid (GC).

Methods: Eighty patients with nasal polyps were initially enrolled in the study. All polyp specimens were obtained prior to treatment. Patients then received daily topical GC spray treatment for one month. Polyp specimens were tested for glucocorticoid receptor (GR) GR-α and GR-β mRNA expression using fluorescent quantitative-reverse transcription-polymerase chain reaction (FQ-RT-PCR). Thirty healthy nasal mucosa tissue samples were tested at the same time.

Results: Forty patients finished the study and were divided into two groups: GC-sensitive (n=26) and GC-insensitive (n=14), according to treatment results. GR-β mRNA expression in the nasal polyp tissues of the GC-insensitive group (5.72±0.58×102 copies/μg) was higher than that in the GC-sensitive group (4.82±0.28×102 copies/μg, P < 0.05) and in the normal nasal mucosa group (4.44±0.35×102 copies/μg, P < 0.01). There was also a difference in the relative expression of GR-α and GR-β between the GC-sensitive group (GR-α/GR-β= 829.42±67.36) and the GC-insensitive group (535.7±89) (P < 0.01).

Conclusion: GR-β mRNA was highly expressed in patients with nasal polyps. Down- regulation of GR-α mRNA suggests the existence of glucocorticoid insensitivity. Expression of GR-β may plays an important role in the evaluation of the glucocorticoid therapeutic effect in patients with nasal polyps.
Comparison of colchicine versus prednisolone in recurrent aphthous stomatitis: A double-blind randomized clinical trial
Authors: Pakfetrat Atessa , Mansourian Arash , Momen-Heravi Fatemeh , Delavarian Zahra , Momen-Beitollahi Jalil , Khalilzadeh Omid , Basir-Shabestari Samira
Published: May 2017

Purpose: Recurrent aphthous stomatitis (RAS) is one of the most common ulcers of the oral cavity with a reported prevalence of 5- 50%. There is still no definitive treatment for RAS; however, immunosuppressive and immunomodulant agents have been proposed. In this study, we compared the therapeutic effects of 5 mg/d prednisolone with 0.5 mg/d colchicine in the treatment of RAS.

Methods: In a double-blind randomized clinical trial, 34 patients with RAS were randomly divided into two groups for treatment with prednisolone or colchicine. All patients took the medication for three months and were assessed at two weeks intervals. The groups were compared for size and number of lesions, severity of pain and burning sensation, duration of pain-free episodes and any side effects of the prescribed medicines. Both colchicine and prednisolone treatments significantly reduced RAS (p < 0.001). No significant differences in size and number of lesions, recurrence and severity of pain and duration of pain-free period were seen between the two treatment groups. Colchicine (52.9%) had significantly more side effects than prednisolone (11.8%).

Conclusion: Low dose prednisolone and colchicine were both effective in treating RAS. Given that the two therapies had similar efficacy, yet colchicine was associated with more side effects, , 5mg/d of prednisolone seems to be a better alternative in reducing the signs and symptoms of the disease.
A framework for resolving disagreement during end of life care in the critical care unit
Authors: Choong Karen , Cupido Cynthia , Nelson Erin , Arnold Donald M , Burns Karen , Cook Deborah , Meade Maureen
Published: May 2017

Background: End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically “futile” care. Such disagreements can cause tension and moral distress among families and clinicians.

Purpose: To outline the roles and responsibilities of physicians, substitute decision makers, and the judicial system when decisions must be made on behalf of incapable persons, and to provide a framework for conflict resolution during end-of-life decision-making for physicians practicing in Canada.

Source: We used a case-based example to illustrate our objectives. We employed a comprehensive approach to understanding end-of-life decision making that included: 1) a search for relevant literature; 2) a review of provincial college policies; 3) a review of provincial legislation on consent; 4) a consultation with two bioethicists and 5) a consultation with two legal experts in health law.

Principal Findings: In Canada, laws about substitute decision-making for health care are primarily provincial or territorial. Thus, laws and policies from professional regulatory bodies on end-of-life care vary across the country. We tabulated the provincial college policies on end-of-life care and the provincial legislation on consent and advance directives, and constructed a 10-step approach to conflict resolution.

Conclusion: Knowledge of underlying ethical principles, understanding of professional duties, and adoption of a process for mediation and conflict resolution are essential to ensuring that physicians and institutions act responsibly in maintaining a patients’ best interests in the context of family-centred care.
Clinical outcome and left ventricular remodeling in AMI patients with insufficient myocardial reperfusion after recanalization
Authors: Jin Jun , Wang Hong , Song Yao-Ming , Li Ai-Ming , Qin Jun , Yu Xue-Jun , Geng Zhao-Hua , Zhao Gang , Liu Zhen , Huang Lan
Published: May 2017

Aim: Myocardial contrast echocardiography (MCE) is effective in predicting myocardial viability and functional recovery on a segmental level in patients with acute myocardial infarction (AMI). In this study, we investigated whether insufficient myocardial reperfusion plays an important role in left ventricular (LV) remodeling and functional recovery in patients with thrombolysis in myocardial infarction (TIMI) flow grade 3 and corrected TIMI frame count (CTFC) < 40 after recanalization of the infarct-related artery.

Method: Patients underwent intracoronary injection of microbubbles for echocardiographic assessment of myocardial microvascular perfusion, wall motion score, LV volume and ejection function (EF) at baseline, 30 minutes, one month and six months after recanalization. The patients with MCESI < 1 were considered to have insufficient myocardial reperfusion (group A, n=11), while the patients with MCESI≥1 were considered to have sufficient myocardial reperfusion (group B, n=47) after AMI recanalization.

Results: The wall motion score index (WMSI) and the left ventricular ejection fraction (LVEF) showed significant improvement at 1 month and 6 months in group B, but only at six months in group A. Left ventricular end-systolic and end-diastolic volumes (LVESV and LVEDV) were also significantly decreased at one and six months in group B. WMSI, LVESV, LVEDV and LVEF were significantly improved in group B in comparison with group A at one month and six months (P < 0.01). By six months, significant correlations were seen in all patients between MCESI and changes in LVESV, LVEDV and LVEF at 6 months. Similar correlations were observed between the myocardial regional blood flow (Q) and changes in LVESV , LVEDV and LVEF..

Conclusion: Insufficient myocardial reperfusion was a strong independent predictor of LV remodeling and functional recovery in AMI patients with TIMI flow grade 3 and CTFC < 40 after recanalization. MCE has important additional value for prognosis and risk assessment in patients with acute myocardial infarction following recanalization.
Effects of statin use on total oxidant and antoxidant capacity and ceruloplasmin activity
Authors: Buyukhatıpoglu Hakan , Sezen Yusuf , Yildiz Ali , Guntekin Unal , Bas Memduh , Polat Mustafa , Demirbag Recep , Taskin Abdullah , Celik Hakim , Aksoy Nurten
Published: May 2017

Purpose: Oxidative damage plays an important role in atherosclerosis development. Statin drugs have anti-oxidant properties, but the clinical value of their antioxidant properties remains unclear. In this study, our aims were: (1) to assess the anti-oxidant effects of statins in patients with coronary artery disease (CAD) using a newly developed valid measure of total oxidant and anti-oxidant capacity; and (2) to identify whether statins influence ceruloplamin levels.

Methods: Within a cross-sectional study, 67 dyslipidemic CAD patients on atorvastatin for at least three months were compared with 69 age- and gender-matched CAD patients not using atorvastatin. All patients were either newly-diagnosed with or already had established CAD. Patients and controls were selected from among patients who had undergone coronary angiography for a variety of reasons. Immediately prior to angiography, plasma total oxidant and antioxidant capacity and ceruloplasmin (Cp) levels were measured by means of a relatively new and highly-reliable method.

Results: Total oxidant capacity levels were significantly lower and total antioxidant capacity significantly higher in those on atorvastatin; serum seruloplasmin levels also were significanly increased in the atorvastatin groups (all p < 0.05). On multivariate analysis, atorvastatin use was a significant determinant of Cp increase, independent of any antioxidant effect.

Conclusions: This study clearly demonstrates increased anti-oxidant capacity and decreased oxidative stress with statin use. Atorvastatin use may also increase Cp levels although this effect appears to be independent of its anti-oxidant effects.
Differences in glycemic control and survival predict higher ESRD rates in diabetic first nations adults
Authors: Dyck Roland F , Sidhu Nirmal , Klomp Helena , Cascagnette Paul J , Teare Gary F
Published: May 2017

Purpose: Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and other Saskatchewan residents (OSK) by renal function stage.

Methods: Prevalent diabetes cases in 2005/06 were identified in Saskatchewan’s two largest health regions using administrative databases, and linked with centralized laboratory tests. They were sub-divided into five stages of renal function using estimated glomerular filtration rates (eGFR) that were determined in 992 of 2,321 FN (42.7%) and 14,054 of 21,886 OSK (64.2%). Age, sex, urine microalbumin (MA), glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C) and two year mortality risk was compared for all subjects.

Results: Diabetic FN were younger (mean age 52.7 vs. 64.2, p < 0.0001), more likely to be female (59.6% vs.45.4%, p < 0.001), had increased MA (56.6% vs. 48.4%, p < 0.0001) and displayed higher mean A1C levels (8.16% vs.7.36%, p < 0.0001) than OSK. Despite a larger proportion having eGFR’s > 60 ml/min (87.0% vs.77.3%, p < 0.001), FN were also more likely to have ESRD (2.3% vs.0.8%, p < 0.001). Although FN with eGFR’s > 30 ml/min experienced higher age/sex adjusted mortality risk than OSK, the trends for both adjusted and unadjusted mortality risks for those with advanced pre-ESRD renal failure were lower for FN than for OSK.

Conclusions: Elevated rates of ESRD experienced by FN with diabetes are related to poorer glycemic control at all levels of renal function, and lower age-related mortality at advanced stages of chronic kidney disease.
Administration of minocycline ameliorates damage in a renal ischemia/reperfusion injury model
Authors: Xia Dan , Shen Kezhen , Zhong Weidr , Pan Hao
Published: May 2017

Purpose: The purpose of this study was to investigate the effects of minocycline on the renal dysfunction and injury caused by bilateral ischemia/reperfusion (I/R) of murine kidneys in vivo.

Methods: Male C57BL/6 mice were administered minocycline (45 mg/kg i.v.) or saline (0.9%, v/v, NaCl) 36 hours prior to I/R. Mice were subjected to bilateral renal ischemia (35 min) followed by reperfusion (6 hours). Serum creatinine (sCr) and blood urea nitrogen (BUN) levels were measured. Additionally, renal superoxide dismutase (SOD) levels, malondialdehyde (MDA) levels and myeloperoxidase (MPO) activity were determined. The expression of intercellular adhesion molecule-1 (ICAM-1), caspase-3, caspase-8 and caspase-9 was determined using real time RT-PCR and Western blot analysis.

Results: Minocycline administration significantly reduced the increases in sCr and BUN caused by I/R, indicating attenuation of renal dysfunction and injury, and reduced histological evidence of renal damage caused by I/R. Minocycline administration also markedly reduced the evidence of oxidative stress (MPO activity, SOD and MDA levels), inflammation (ICAM-1 expression and MPO activity) and apoptosis (caspase-3, caspase-8 and caspase-9 expression) in mouse kidneys subjected to I/R.

Conclusion: These findings provide good evidence that minocycline can reduce the renal dysfunction and injury caused by I/R of the kidney. Its mechanism may involve suppression of apoptosis, inflammatory response and oxidative stress.
Adiposity and pulmonary function: Relationship with body fat distribution and systemic inflammation
Authors: Lessard Andréa , Alméras Nathalie , Turcotte Hélène , Tremblay Angelo , Després Jean-Pierre , Boulet Louis-Philippe
Published: May 2017

Purpose: Obesity is associated with changes in pulmonary function and increased systemic inflammation. We explored the relationships among adiposity, body fat distribution indices, serum inflammatory markers and pulmonary function.

Methods: This was a post-hoc cross-sectional analysis that included subjects who had previously participated in randomized studies on obesity at our centre. Non-smoking sedentary men (282 subjects, mean age 42) without respiratory diseases were studied. BMI, waist circumference (WC), visceral and subcutaneous adipose tissue (AT), lung residual volume (RV), vital capacity (VC) and expiratory reserve volume (ERV) were measured. Serum leptin, adiponectin, tumor necrosis factor alpha (TNF-α) and high-sensitive C-reactive protein (hs-CRP) levels were measured.

Results: In subjects with metabolic syndrome (n=124), percent predicted ERV and RV were significantly associated with BMI (ERV: r=-0.19, p=0.02, RV: r=-0.28, p=0.0007), WC (r=-0.20, p=0.02, r=-0.26, p=0.002), visceral (r=-0.22, p=0.007, r=-0.25, p=0.002) and subcutaneous AT (r=-0.19, p=0.02, r=-0.28, p=0.0007). Percent predicted VC correlated with visceral (r=-0.20, p=0.02) and subcutaneous AT (r=-0.18, p=0.03). Leptin was strongly correlated with BMI (MS/no-MS: r=0.52, p=0.0005/r=0.62, p < 0.0001), WC (r=0.41, p=0.008/r=0.49, p < 0.0001), visceral (r=0.27,p=0.09/0.43, p < 0.0001) and subcutaneous AT (r=0.46, p=0.003/r=0.66, p < 0.0001), while adiponectin levels were associated in subjects with no-MS with WC (r=-0.20, p=0.01), visceral (r=-0.22, p=0.008), and subcutaneous AT (r=-0.17, p=0.05). When adjusted for anthropometric measures, neither ERV, RV nor VC was significantly correlated with serum leptin, adiponectin, TNF-α, or hs-CRP levels.

Conclusion: These results suggest that the influence of obesity on lung function in healthy subjects is mostly mediated by mechanical factors. Furthermore, not only BMI but also the pattern of fat distribution should be considered when studying associations between adiposity indices and mechanical or inflammatory variables potentially associated with pulmonary function.
Clinician Investigator Training in Canada: A Review
Authors: Hayward Catherine P , Danoff Deborah , Kennedy Margaret , Lee A Curtis , Brzezina Stacey , Bond Ursel
Published: May 2017

Purpose: The Royal College of Physicians and Surgeons of Canada undertook a review of its Clinician Investigator Program (CIP), 13 years after launching the program in response to shortages in clinical investigators. The primary study goals were to determine the outcomes, impact, strengths and weaknesses of CIP.

Methods: Focus groups and telephone interviews with current and past program directors (PD) and a detailed survey of current and former trainees were conducted. Thirteen PD and 45% of current and former trainees from 10 CIP participated.

Results: Since 1995, 12 CIP have been accredited and 553 residents have enrolled in CIP, with 194 completing CIP and residency training by 2008. PD recognized CIP as an excellent program that produces highly qualified clinical investigators; important for faculty renewal. Both trainees and PD identified the need to improve CIP funding. Most (84%) CIP trainees did not have prior graduate degrees. Most alumni had completed Masters (58%) or Doctoral (39%) programs during CIP and published on their CIP research (97%). Among alumni who completed CIP and residency, many obtained an academic appointment with protected time for research, with 39% receiving an external career award. Many (60%) alumni reported no drawbacks to CIP and recognized the added values included Royal College recognition, structured training, pursuit of graduate studies, integration of clinical/research training and enhanced mentorship.

Conclusion: Since the progam’s inception, the number of CIP in Canada has grown. CIP are recognized as important mechanisms for integrating clinical and research training during residency to produce highly qualified clinician investigators.
The effect of the duration of clopidogrel use on hsCRP levels after stenting the target vessel in patients with acute coronary syndrome
Authors: Çekici Yusuf , Korkmaz Hasan , Çelik Ahmet , Bilen Mehmet Nail , Bulut Musa , Akbulut Mehmet
Published: May 2017

Purpose: The aim of this study is to investigate the relationship between the duration of clopidogrel use and the inflammation process after acute coronary syndrome in patients who received bare metal stent (BMS) or drug eluting stent (DES).

Method: Sixty patients with acute coronary syndrome who received a stent were divided into three groups: 20 patients with BMS receiving clopidogrel for one month (BMS1 group), 20 patients with BMS receiving clopidogrel for 6 months (BMS6 group), and 20 patients with DES receiving clopidogrel for 6 months (DES group). High sensitive C-reactive protein (hsCRP, mg/dL) was measured at baseline, and then at first, third and sixth post-operative month.

Results: The inital hsCRP levels were similar and decreased significantly in all groups by one month of clopidogrel treatment (from 7.1±1.9 to 3.8±2.3 in BMS1 group, p=0,002, from 6.5±2.8 to 4.3±2.5 in BMS6 group, p= 0,01 and from 7.7±2 to 3.6±2.4 in DES group, p < 0.001). In the BMS1 group, after termination of the clopidogrel therapy after the first month, hsCRP levels increased again at the third and sixth months. In the BMS6 and DES groups, hsCRP levels continued to show a decrease at the third month and sixth months.

Conclusions: Clopidogrel decreases hsCRP levels in patients with acute coronary syndrome. It might be desirable to lengthen the duration of the clopidogrel therapy to maintain its anti-inflammatory effects.
Factors associated with cumulative research funding of investigators from CIHR – a major health-research funding agency
Authors: Raghavan Malathi
Published: May 2017

Purpose: Few systematic studies have focused on determinants of cumulative research funding (CRF), a measure of research productivity among career researchers world-wide. Using researchers funded by the Canadian Institutes for Health Research (CIHR), this exploratory study quantifies the association between CIHR-investigator roles and CRF obtained from the CIHR.

Methods: CIHR grants and awards obtained in fiscal years 1999-2006 by non-trainee principal investigators (PI) and by supervisors of CIHR trainee awards were used to determine investigator-level CRF. Log-transformed CRF was regressed on investigator role as CIHR-salary award recipient or supervisor of CIHR-trainee award recipients after adjustment for number of project-years, research area, and PI status. Number of publications in life sciences and biomedical journals from January 2000 to August 2007 was compared among 80 randomly-selected CIHR-investigators who were supervisors (n=40) and non-supervisors (n=40). Reported results were considered significant at P-value < 0.05.

Results: Multiple regression analysis based on 6515 CIHR-investigators indicated that salary award recipients were associated with a 29.5% higher CRF but the magnitude of this positive association was inversely associated with time since first receiving salary award. Supervisors were associated with, on average, a 13.1% decrease in CRF; increasing numbers of trainees supervised was associated with decreasing CRF. Earlier recipients of grants and salary awards were more likely also supervisors. The median number of publications for supervisors was higher than that for non-supervisors (31 vs. 11.5).

Conclusions: Demonstrated associations between investigator-level CRF and predictors suggest that CRF should be considered in the context of investigators’ multiple roles. The study, without establishing causality, also documents evidence of multi-lateral returns to the enterprise of academic research from salary and trainee awards. The major limitation is that CRF and predictors are derived from a single funding agency. Findings should be viewed as preliminary and should serve to develop hypotheses for future, comprehensive research.
Elevated serum receptor activator of nuclear factor kappa B ligand and osteoprotegerin levels in late-onset male hypogonadism
Authors: Pepene Carmen E , Crişan Nicolae , Coman Ioan
Published: May 2017

Purpose: Studies that analyze the levels of osteoprotegerin (OPG) or receptor activator of nuclear factor kappa B ligand (RANKL) in hypogonadal men, the majority of whom have prostate cancer or are undergoing androgen-deprivation therapy, are few and inconclusive.

Methods: 81 men aged 69.3 ± 0.8 years (39 men with late-onset hypogonadism and 42 age-matched controls) were recruited. Serum levels of OPG, total soluble RANKL (sRANKL), total and free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), follicle-stimulating hormone, luteinizing hormone (LH), prolactin, bone-specific alkaline phosphatase (BAP) and β-Cross Laps were assessed.

Results: Compared with controls, both OPG (p = 0.023) and sRANKL (p = 0.010) serum levels were increased in men with late-onset hypogonadism; however, when expressed as a ratio, sRANKL/OPG, the two groups were not significantly different. Simple and age-adjusted analyses showed that OPG was inversely related to FT and positively related to SHBG, E2 and BAP. In the patient population, LH demonstrated statistically significant correlations with both OPG (r = 0.274, p = 0.013) and sRANKL (r = 0.276, p = 0.018). Multiple regression analysis retained age, SHBG, E2 and BAP as independent predictors of OPG, explaining 27.71% of serum OPG variability.

Conclusions: Late-onset hypogonadism is associated with enhanced RANKL activity. Increased bone turnover-related OPG levels may act as a coupling factor between bone resorption and formation. The results suggest anti-RANKL-agents as therapeutic tools in osteoporotic men with late-onset hypogonadism.
Correlation of new bone metabolic markers with conventional biomarkers in hemodialysis patients
Authors: Takano Mari , Okano Kazuhiro , Tsuruta Yuki , Yamashita Tetsuri , Echida Yoshihisa , Miwa Naoko , Kimata Naoki , Akiba Takashi , Nitta Kosaku
Published: May 2017

Background: New bone metabolic markers have become available clinically for evaluating chronic kidney disease mineral and bone disorders (CKD-MBD). The aim of this study was to correlate these new bone metabolic markers with conventional markers in regular hemodialysis (HD) patients.

Methods: One hundred forty three HD patients underwent cross-sectional assessment. Two bone formation markers, bone-specific alkaline phosphatase (BAP) and osteocalcin (OC), and one bone resorption marker, amino-terminal telopeptides of type 1 collagen (NTx), were selected for study.

Results: Both circulating OC and NTx levels showed positive correlations with serum intact parathyroid hormone (iPTH) levels. The levels of NTx and OC showed a strongly positive correlation, although they are known to be markers of different aspects of bone metabolism: bone formation and resorption. Patients with high iPTH (≥300pg/mL) had significantly higher levels of all the three bone markers compared with patients with low or normal iPTH .

Conclusion: Serum OC and NTx levels may be useful markers of serum iPTH levels for evaluating bone turnover in HD patients and may eventually prove useful in the management of patients with CKD-MBD.
Correlation of synovial fluid HMGB-1 levels with radiographic severity of knee osteoarthritis
Authors: Li Zhan-Chun , Cheng Guang-Qi , Hu Kong-Zu , Li Mao-Qiang , Zang Wei-Ping , Dong Yu-Qi , Wang Wei-Li , Liu Zu-De
Published: May 2017

Purpose: This study measured high-mobility group box 1 (HMGB-1) levels in serum and synovial fluid (SF) in patients with primary knee osteoarthritis (OA) and correlated these levels with radiographic disease severity.

Methods: Seventy-eight OA patients and 30 controls were enrolled in this study. All OA patients were scored according to the Kellgren-Lawrence (KL) grading system. HMGB-1 levels were measured by enzyme-linked immunosorbent assay (ELISA).

Results: SF HMGB-1 levels were significantly higher in knee OA patients, compared with controls (P < 0.01). Moreover, SF HMGB-1 levels were positively associated with KL scores (P < 0.01). Multinomial logistic regression demonstrated that the SF HMGB-1 level was an independent factor for radiographic severity of OA (P=0.002); however, serum HMGB-1 levels did not differ significantly between OA patients and controls and did not correlate with KL scores (P > 0.05).

Conclusion: These results demonstrate that HMGB-1 levels in SF of knee OA patients are independently associated with radiographic disease severity.
Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction
Authors: Yazici Huseyin U , Poyraz Fatih , Sen Nihat , Tavil Yusuf , Turfan Murat , Tulmaç Murat , Abacı Adnan
Published: May 2017

Purpose: Mean platelet volume (MPV) is an indicator of platelet activation, which is a central process in the pathophysiology of coronary heart disease. Metabolic syndrome (MS) may lead to worsened left ventricular systolic function by causing recurrent thrombotic events and by aggravating systemic inflammation in the course of acute myocardial infarction. The present study was designed to investigate the relationship between MPV and left ventricular systolic function in patients with metabolic syndrome who had first ST-elevation myocardial infarction.

Methods: MPV was measured on admission in 33 patients who had preserved left ventricle systolic function (mean age, 56.9±10.2 years) and in 48 patients who had depressed left ventricle systolic function (mean age, 57.9±10.5 years) with metabolic syndrome and first ST elevation myocardial infarction. Depressed left ventricle systolic function was defined as ≤50% ejection fraction value. MPV levels were compared in the two groups.

Results: MPV was significantly higher in patients with depressed left ventricle systolic function in comparison with patients showing preserved left ventricle systolic function (p=0.02). Logistic regression analysis showed an independent relationship between MPV and deteriorated left ventricular systolic function, even after adjustment for potential confounders (1.08 (1.04-1.20), CI: 95%, p=0.02).

Conclusions: Increased MPV on admission can be associated with degree of left ventricle systolic depression in patients with metabolic syndrome with first ST-elevation myocardial infarction. MPV may prove to be useful as a prognostic marker in patients with metabolic syndrome and ST elevation MI.
Knowledge translation: Principles and practicalities for trainees within interdisciplinary health research teams
Authors: Collisson Beverly A , Benzies Karen , Mosher Andrea A , Rainey Kelly J , Tanaka Satomi , Tracey Curtis , Xu Chen , Olson David M
Published: May 2017

Within a dynamic health research environment with trends toward increasing accountability, governments and funding agencies have placed increased emphasis on knowledge translation (KT) as a way to optimize the impact of research investments on health outcomes, research products and health service delivery. As a result, there is an increasing need for familiarity with the principles of KT frameworks and components of KT strategies. Accordingly, health research trainees (graduate students and post-doctoral fellows) must be supported to enhance their capacity to understand KT principles and the practicalities of implementing effective KT practices.In this paper, the unique opportunities and challenges that trainees within an interdisciplinary research team encounter when they begin to understand and apply constructive and relevant KT practices are considered. Our commentary is based on trainee experiences within the Preterm Birth and Healthy Outcomes Team (PreHOT), an interdisciplinary research team.
Re: Clin Invest Med. 2003 Feb;26(1):38-44
Authors: _ _
Published: May 2017

Clinical and Investigative Medicine wishes to inform its readers of the following incident of redundant publication. The publication: Kang AK, Miller JA. Impact of gender on renal disease: the role of the renin angiotensin system. Clin Invest Med. 2003 Feb;26(1):38-44, contains a substantial amount of information and text reported in the previously published article, Kang AK, Miller JA. Effects of gender on the renin-angiotensin system, blood pressure, and renal function. Curr Hypertens Rep. 2002 Apr;4(2):143-51.
Re: Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction
Authors: Acikgoz Savaş , Ege Meltem R , Guray Yesim
Published: May 2017

We have read with great interest the recently published report of Yazici et al. [1], which investigates the relationship between mean platelet volume (MPV) and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction. The authors demonstrated that increased MPV on admission can be associated with the degree of left ventricle systolic depression in these patients.

It has been reported that MPV, a measure of platelet size, reflects platelet function and activity...
Quality of life and metabolic disorders in patients with obstructive sleep apnea
Authors: Bulcun Emel , Ekici Aydanur , Ekici Mehmet
Published: May 2017

Purpose: Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects.

Methods: Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated.

Results: The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 ± 9.6 years and 43.0 ± 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 ± 4.5 and 27.1 ± 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA.

Conclusion: The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life.
Subcutaneous versus intraperitoneal insulin for patients with diabetes mellitus on continuous ambulatory peritoneal dialysis: Meta-analysis of non-randomized clinical trials.
Authors: Almalki Mussa H. , Altuwaijri Mansour A. , Almehthel Mohammed S. , Sirrs Sandra M. , Singh R. Suneet
Published: May 2017

Background: Diabetes mellitus is one of the leading causes of end stage renal disease. Use of intraperitoneal (IP) nsulin in diabetic patients on peritoneal dialysis (PD) can restore glucose control to near normal values. The safety and efficacy of this method is unclear.

Methods: We performed a meta-analysis to study the safety and efficacy of IP insulin administration in diabetic patients on PD. The primary outcome measures is glycemic control: secondary outcome measures were plasma lipids, insulin dose requirement/day and the risk of peritonitis and hepatic subcapsular steatosis.
Medline, EMBASE, Cochrane Central Register of Controlled Trials, and reference lists of eligible studies were searched. Eligible studies included randomized and non-randomized controlled trials that allocated adult PD diabetic patients to IP insulin and subcutaneous (SC) insulin.

Results: Twenty one citations were identified and three met the eligibility criteria. Glycemic control with IP insulin, as assessed with HbA1C, was equal to or better than that obtained with SC insulin: weighted mean difference was −1.49 % (95% CI: -2.17 to - 0.27, p=0.0001). The insulin dose required was more than two-fold higher in the IP treatment. Serum HDL-cholesterol decreased during IP insulin therapy while serum triglyceride (TG) concentration tended to increase, in comparison with levels seen in patients treated with SC insulin.

Conclusions: Use of IP insulin provides adequate glycemic control, which appears superior to that seen following treatment with conventional SC insulin. The plasma lipids are adversely affected by IP insulin, possibly contributing to increased cardiovascular risk. Data are limited and further studies are needed to assess for the long-term safety of this approach.