Home About us Contact
|
Home About us Contact | ||
|
|
||
Clinical Complications (clinical + complications)
Selected AbstractsFirst missense mutation in the SOST gene causing sclerosteosis by loss of sclerostin function,HUMAN MUTATION, Issue 7 2010Elke Piters Abstract Sclerosteosis is a rare bone dysplasia characterized by greatly increased bone mass, especially of the long bones and the skull. Patients are tall, show facial asymmetry and often have syndactyly. Clinical complications are due to entrapment of cranial nerves. The disease is thought to be due to loss-of-function mutations in the SOST gene. The SOST gene product, sclerostin, is secreted by osteocytes and transported to the bone surface where it inhibits osteoblastic bone formation by antagonizing Wnt signaling. In a small Turkish family with sclerosteosis, we identified a missense mutation (c.499T>C; p.Cys167Arg) in exon 2 of the SOST gene. This type of mutation has not been previously reported and using different functional approaches, we show that it has a devastating effect on the biological function of sclerostin. The affected cysteine is the last cysteine residue of the cystine-knot motif and loss of this residue leads to retention of the mutant protein in the ER, possibly as a consequence of impaired folding. Together with a significant reduced ability to bind to LRP5 and inhibit Wnt signaling, the p.Cys167Arg mutation leads to a complete loss of function of sclerostin and thus to the characteristic sclerosteosis phenotype. © 2010 Wiley-Liss, Inc. [source] Palpable splenomegaly in children with haemoglobin SC disease: Haematological and clinical manifestationsINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2000S.A. Zimmerman Summary This study aimed to investigate the prevalence of palpable splenomegaly in children with haemoglobin SC (Hb SC) disease, and to determine the haematological and clinical manifestations of splenomegaly in this patient population. We performed a retrospective chart review of 100 patients with Hb SC over 2 years of age followed by the Duke University Paediatric Sickle Cell Program with serial physical examinations and laboratory measurements. Palpable splenomegaly was present in 34% of patients and was more common in males (P = 0.029). Children with splenomegaly had a significantly lower average haemoglobin concentration (10.3 vs. 10.8 g/dl, P = 0.011) and lower platelet count (237 vs. 314 × 109/l, P < 0.001) than those without splenomegaly. Children with measurements both before and after the onset of splenomegaly had a significant decrease in the platelet count (279 vs. 216 × 109/l, P < 0.001) and white blood cell count (9.1 vs. 7.9 × 109/l, P = 0.04) after splenomegaly was identified. Clinical complications included acute splenic sequestration in 12% of children (median age 5.4 years), and hypersplenism with chronic thrombocytopenia in another 10% of patients (median age 10.6 years). Splenomegaly is a common physical finding in children with Hb SC disease and is often associated with mild cytopenias. Clinical complications of splenomegaly include acute splenic sequestration in younger patients and hypersplenism with chronic thrombocytopenia in older children. [source] Clinical complications following thyroid fine-needle biopsy: a systematic reviewCLINICAL ENDOCRINOLOGY, Issue 2 2009Stergios A. Polyzos Summary Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive and generally safe diagnostic procedure in the management of thyroid nodules. Post-FNB local pain and minor haematomas are the most common complications, while serious complications seem to be rare. Given that use of FNB minimizes unnecessary surgery and subsequent operative morbidity and mortality as well as the fact that the majority of FNB complications resolve spontaneously, the overall safety of FNB is not questioned. However, awareness of the potential complications and careful estimation of the risk-benefit ratio in an individual basis may further decrease the low morbidity of FNB. In this systematic review we tried to collect and summarize all reported clinical complications following diagnostic thyroid FNB, aiming to make physicians aware of possible complications and to provide preventive measures to avoid them. [source] The role of taurine in diabetes and the development of diabetic complicationsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2001Svend Høime Hansen Abstract The ubiquitously found ,-amino acid taurine has several physiological functions, e.g. in bile acid formation, as an osmolyte by cell volume regulation, in the heart, in the retina, in the formation of N -chlorotaurine by reaction with hypochlorous acid in leucocytes, and possibly for intracellular scavenging of carbonyl groups. Some animals, such as the cat and the C57BL/6 mouse, have disturbances in taurine homeostasis. The C57BL/6 mouse strain is widely used in diabetic and atherosclerotic animal models. In diabetes, the high extracellular levels of glucose disturb the cellular osmoregulation and sorbitol is formed intracellularly due to the intracellular polyol pathway, which is suspected to be one of the key processes in the development of diabetic late complications and associated cellular dysfunctions. Intracellular accumulation of sorbitol is most likely to cause depletion of other intracellular compounds including osmolytes such as myo -inositol and taurine. When considering the clinical complications in diabetes, several links can be established between altered taurine metabolism and the development of cellular dysfunctions in diabetes which cause the clinical complications observed in diabetes, e.g. retinopathy, neuropathy, nephropathy, cardiomyopathy, platelet aggregation, endothelial dysfunction and atherosclerosis. Possible therapeutic perspectives could be a supplementation with taurine and other osmolytes and low-molecular compounds, perhaps in a combinational therapy with aldose reductase inhibitors. Copyright © 2001 John Wiley & Sons, Ltd. [source] HbA1c as a screening tool for detection of Type 2 diabetes: a systematic reviewDIABETIC MEDICINE, Issue 4 2007C. M. Bennett Abstract Aim To assess the validity of glycated haemoglobin A1c (HbA1c) as a screening tool for early detection of Type 2 diabetes. Methods Systematic review of primary cross-sectional studies of the accuracy of HbA1c for the detection of Type 2 diabetes using the oral glucose tolerance test as the reference standard and fasting plasma glucose as a comparison. Results Nine studies met the inclusion criteria. At certain cut-off points, HbA1c has slightly lower sensitivity than fasting plasma glucose (FPG) in detecting diabetes, but slightly higher specificity. For HbA1c at a Diabetes Control and Complications Trial and UK Prospective Diabetes Study comparable cut-off point of , 6.1%, the sensitivity ranged from 78 to 81% and specificity 79 to 84%. For FPG at a cut-off point of , 6.1 mmol/l, the sensitivity ranged from 48 to 64% and specificity from 94 to 98%. Both HbA1c and FPG have low sensitivity for the detection of impaired glucose tolerance (around 50%). Conclusions HbA1c and FPG are equally effective screening tools for the detection of Type 2 diabetes. The HbA1c cut-off point of > 6.1% was the recommended optimum cut-off point for HbA1c in most reviewed studies; however, there is an argument for population-specific cut-off points as optimum cut-offs vary by ethnic group, age, gender and population prevalence of diabetes. Previous studies have demonstrated that HbA1c has less intra-individual variation and better predicts both micro- and macrovascular complications. Although the current cost of HbA1c is higher than FPG, the additional benefits in predicting costly preventable clinical complications may make this a cost-effective choice. [source] Radiologically guided percutaneous fine-needle aspiration biopsy of the liver: Retrospective study of 119 cases evaluating diagnostic effectiveness and clinical complicationsDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2002Ph.D., Ziwen Guo M.D. Abstract We reviewed 119 percutaneous, radiologically guided fine-needle aspirations (FNA) from 114 patients with liver masses to evaluate diagnostic effectiveness and complications of this procedure. Satisfactory material was obtained in 118 cases (99%), of which 78 were diagnosed as positive (66%), three suspicious (2%), five atypical (4%), and 32 (27%) as negative for malignancy. Compared to surgical biopsy (48 cases) and clinical data, the sensitivity and specificity of FNA for malignancy was 95.1% and 100%, respectively, yielding a positive predictive value of 100% and a negative predictive value of 88.8%. Four cytology cases (3.4%) were false-negatives (FN); all were interpretive errors. Four FN surgical biopsies (8.3%) were sampling errors. Minor complications occurred in three cases (2.5%). We conclude that FNA is safe and effective for determining the malignant potential of liver masses and should be the procedure of choice. Our experience suggests that having a pathologist present in the radiology suite provides optimal patient care. Diagn. Cytopathol. 2002;26:283,289. © 2002 Wiley-Liss, Inc. [source] Hypertrophic cardiomyopathy in the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2010Toru Kubo Hypertrophic cardiomyopathy (HCM) is a relatively common genetic cardiac disorder with heterogeneous morphological, functional and clinical features. Although the risk of sudden death and incapacitating symptoms in young patients has been focused upon, the disease has been found with increasing frequency in elderly patients. However, there have been few studies on clinical features of HCM in the elderly. We established a cardiomyopathy registration study in Kochi Prefecture, which is one of the most aged communities in Japan, to provide detailed descriptions of the clinical features of HCM in a community-based patient cohort. The unselected regional HCM population consisted largely of elderly patients (70% of the study cohort being ,60 years of age at registration), although HCM has been regarded largely as a disease of the young. Cardiac hypertrophy that becomes clinically apparent late in life can be a genetic disorder, and mutations in the cardiac myosin-binding protein C gene are the most common cause of late-onset or elderly HCM. In the morphological features, sarcomere gene defects seem to have a predilection for a crescent-shaped left ventricular cavity with reversed septal curvature even in elderly patients, although an ovoid left ventricular shape was frequently seen in elderly patients in previous clinical studies on morphological characteristics of HCM. In middle-aged or elderly patients with HCM, heart failure and embolic events, which were strongly associated with atrial fibrillation, were very important. It is important to manage HCM patients from the standpoint of longitudinal evolution in order to prevent those clinical complications. [source] A panel of multiple markers associated with chronic systemic inflammation and the risk of atherogenesis is detectable in asthma and chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 6 2007Tsu-Lan Wu Abstract Asthma and chronic obstructive pulmonary disease (COPD) are both lung diseases involving chronic inflammation of the airway. The injury is reversible in asthma whereas it is mostly irreversible in COPD. Both patients of asthma and COPD are known at risk for cardiovascular disease (CVD) and type 2 diabetes (T2DM), nephropathy, and cancer. We measured multiple risk markers for atherogenesis in 55 patients with asthma and 62 patients with COPD. We wanted to know whether risk markers for atherogenesis corresponding to sequence of events of chronic inflammation were also detectable in the airway inflammatory diseases. Elevation of almost all markers involving inflammation of the endothelial cells in the coronary artery were detectable in asthma and COPD involving the inflammation of the epithelial cell lining of the airway. Both the level and % elevation of all markers were found mostly higher in COPD, the more severe form of the lung disease. We believe that these markers are useful for predicting risk of developing clinical complications such as CVD. J. Clin. Lab. Anal. 21:367,371, 2007. © 2007 Wiley-Liss, Inc. [source] Clinical aspects of parvovirus B19 infectionJOURNAL OF INTERNAL MEDICINE, Issue 4 2006K. BROLIDEN Abstract. Parvovirus B19 is a significant human pathogen that causes a wide spectrum of clinical complications ranging from mild, self-limiting erythema infectiosum in immunocompetent children to lethal cytopenias in immunocompromised patients and intrauterine foetal death in primary infected pregnant women. The infection may also be persistent and can mimic or trigger autoimmune inflammatory disorders. Another important clinical aspect to consider is the risk of infection through B19-contaminated blood products. Recent advances in diagnosis and pathogenesis, new insights in the cellular immune response and newly discovered genotypes of human parvoviruses form a platform for the development of modern therapeutic and prophylactic alternatives. [source] Prospective cytomegalovirus monitoring during first-line chemotherapy in patients with acute myeloid leukemiaJOURNAL OF MEDICAL VIROLOGY, Issue 7 2010Saveria Capria Abstract Little is known about the incidence and clinical impact of cytomegalovirus (CMV) infection in patients with acute myeloid leukemia at the time of diagnosis and during chemotherapy. The aims of the present study were to assess prospectively the incidence of active CMV infection in 69 consecutive patients with acute myeloid leukemia and to describe the outcomes of treatment. pp65 antigenemia was monitored at diagnosis, post-induction and post-consolidation chemotherapy, and whenever CMV reactivation was suspected. Patients with pp65 antigenemia received pre-emptive anti-CMV treatment. Fifty-nine patients achieved complete remission. Baseline CMV serology results were available for 56 of the 59 patients: 52 patients (93%) were IgG positive. The overall incidence of pp65 antigenemia in patients in complete remission after chemotherapy was 35% (21/59): 9 patients after induction and 12 post-consolidation. Sixteen of the 21 pp65-positive patients received anti-CMV treatment: 15 as pre-emptive therapy and 1 for interstitial CMV pneumonitis. Five patients received no anti-CMV treatment and did not develop CMV disease. Patients with pp65 antigenemia had more hospital admissions (2.57 vs. 2.16; P,=,0.009), while patients with >10 pp65-positive cells had more clinical complications (8/9 vs. 2/12; P,=,0.002). In conclusion, patients with acute myeloid leukemia receiving chemotherapy should be monitored for active CMV infection. CMV reactivation in these patients was associated with an increased number of hospital admissions, and high levels of pp65 antigenemia were associated with more clinical complications. Controlled studies are needed to assess the relevance of pre-emptive anti-CMV therapy in patients with acute myeloid leukemia receiving chemotherapy. J. Med. Virol. 82: 1201,1207, 2010. © 2010 Wiley-Liss, Inc. [source] VENOUS NEEDLE DISLODGEMENT: HOW TO MINIMISE THE RISKSJOURNAL OF RENAL CARE, Issue 4 2008Jean-Pierre Van Waeleghem SUMMARY Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes. Fatal and near-fatal blood loss due to VND have been described in the literature (ECRI 1998; Sandroni 2005; Mactier & Worth 2007), but published reports represent only the tip of the ice berg, as such incidents are normally handled at a local or national level. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) has produced 12 practice recommendations to help reduce the risk of VND and detect blood leakage as early as possible. A poster summarising these recommendations has been created (Van Waeleghem et al. 2008). [source] Delayed immune-mediated adverse effects related to hyaluronic acid and acrylic hydrogel dermal fillers: clinical findings, long-term follow-up and review of the literatureJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2008J Alijotas-Reig Abstract Introduction Implantation of dermal filler for cosmetic purposes is becoming increasingly common worldwide. It is thought that hyaluronic acid (HA) alone or combined with acrylic hydrogels (HA-AH) does not have severe nor persistent side-effects. However, recent evidence may show that major, local and/or systemic, immediate or delayed adverse effects may appear in relation with its use. Objective To evaluate the clinical complaints, laboratory data, treatment and follow-up of patients with delayed adverse effects related to HA and HA-AH implant fillers. Design Prospective, case-series study of patients filled with HA and HA-AH compounds. Setting The study has been done in a tertiary, teaching university hospital. Patients We report on a series of 25 patients, 15 of them in prospective manner, with severe, delayed side-effects related to HA-AH. Inclusion criteria have been drawn up. Patients with immediate side-effects were excluded. Patients were submitted to a clinical follow-up, battery of blood tests and thorax X-ray films. Besides, a review of the literature was made. We undertook a computed-assisted (MEDLINE), National Library of Medicine, Bethesda, MD, USA, search of the literature from 1996 up to December 2005. Main outcome Clinical evaluation of granulomas, skin manifestations and other local and systemic immune-mediated disorders possibly related to HA and HA-AH fillers or their cumulative interaction with previously administered fillers. Results Of 25 cases, 16 were filled with HA alone and 9 with a HA-AH compounds. Of 15 cases analysed and with long-term follow-up, 10 were filled with HA alone, and the remaining five were filled with a HA-AH. Time latency average up to beginning of symptoms was 13.7 months. Three of these 15 cases had been filled before with silicone and another one with Artecoll. Tender nodules were seen in 14 patients. Systemic manifestations appeared in three cases. Laboratory abnormalities were noted in all studied cases. After 16-month average follow-up, seven patients seem to be cured, and six have recurrent bouts. Two cases were lost during follow-up. Conclusion Although in some cases, these clinical complications might have been associated with previous fillers or with other unknown foreign bodies, we feel that, although infrequently, delayed and recurrent chronic inflammatory and granulomatous reactions may complicate HA and HA-AH implant fillers. [source] Systematic review: the role of self-expanding plastic stents for benign oesophageal stricturesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010A. REPICI Aliment Pharmacol Ther,31, 1268,1275 Summary Background, Treatment of refractory or recurrent benign oesophageal strictures is demanding and surgery may be the only available option. The role of self-expanding plastic stents (SEPS) in the treatment of these strictures is still controversial because of the conflicting results of various studies. Aim, To analyse with regard to SEPS: technical and clinical success, factors associated with outcome, and safety. Methods, Pooled-data analysis of a systematic review of the literature. Clinical success was defined as no need for further endoscopic or surgical treatment after SEPS removal. Results, Data of 10 studies with 130 treated patients were included. SEPS insertion was technically successful in 128 of 130 patients (98%, 95% CI = 96,100%). Clinical success was achieved in 68 patients (52%, 95% CI = 44,61%) and this was found to be lower in those with a cervical localization of the stricture (33% vs. 54%; P < 0.05). Early (<4 weeks) migration of the stent was reported in 19 (24%, 95% CI = 14,32%) cases, while post-insertion endoscopic re-intervention was required in 25 (21%, 95% CI = 14,28%). Major clinical complications occurred in 12 patients (9%, 95% CI = 4,14%), resulting in death of one (0.8%) patient. Conclusions, Our pooled-data analysis showed a favourable risk/benefit ratio when SEPS are applied in patients with recurrent or refractory benign oesophageal strictures. This supports the use of SEPS before referring patients to surgery, and they are a valuable alternative to repeat endoscopic dilation. [source] Splenectomy and thrombosis: the case of thalassemia intermediaJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2010A. T. TAHER See also Mannucci PM. Red cells playing as activated platelets in thalassemia intermedia. This issue, pp 2149,51. Summary.,Background:,Hypercoagulability in splenectomized patients with thalassemia intermedia (TI) has been extensively evaluated. However, clinical and laboratory characteristics of patients who eventually develop overt thromboembolic events (TEE) are poorly studied. Patients/Methods:,Three Groups of TI patients (n = 73 each) were retrospectively identified from a registry involving six centers across the Middle East and Italy: Group I, all splenectomized patients with a documented TEE; Group II, age- and sex-matched splenectomized patients without TEE; and Group III, age- and sex-matched non-splenectomized patients without TEE. Retrieved data included demographics, laboratory parameters, clinical complications, and received treatments that may influence TEE development, and reflected the period prior to TEE occurrence in Group I. Results:,The mean age of Group I patients at development of TEE was 33.1 ± 11.7 years, with a male to female ratio of 33:40. TEE were predominantly venous (95%) while four patients (5%) had documented stroke. Among studied parameters, Group I patients were more likely to have a nucleated red blood cell (NRBC) count , 300 × 106 L,1, a platelet count , 500 × 109 L,1 and evidence of pulmonary hypertension (PHT), or be transfusion naïve. The median time to thrombosis following splenectomy was 8 years. Patients with an NRBC count , 300 × 106 L,1, a platelet count , 500 × 109 L,1, or who were transfusion naive also had a shorter time to thrombosis following splenectomy. Conclusion:,Splenectomized TI patients who will develop TEE may be identified early on by high NRBC and platelet counts, evidence of PHT, and transfusion naivety. [source] CLOSTRIDIUM TETANUS INFECTION IN 13 DOGS AND ONE CATJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004C Bandt Clostridium tetani infection is uncommon in dogs and cats. Up to this point in time just single case reports have been published in veterinary medicine. The goal of this retrospective study was to describe the clinical features and outcome of 13 dogs and one cat affected with Clostridium tetani. The medical records of the last ten year were reviewed. Dogs and cats that were identified as being infected with Clostridium tetani on the basis of characteristic clinical signs and/or bacterial culture from infected wounds were eligible for study inclusion. Thirteen dogs and one cat met the criteria for study inclusion. Six different breeds and mix-breed dogs were affected, German Shepherd dogs (n=4, 29%) and Labrador retriever (n=3, 21%) were the most frequently affected breeds. Observed clinical complications were ventricular aspiration pneumonia (n=7), laryngeal spasm (n=6), hypersalivation (n=4), ventricular tachycardia (n=3), and third degree AV block (n=1). Median days from onset of clinical signs until first signs of improvement were 10 days (range: 9,12 days). Median hospitalisation time was 18 days (range: 14,22 days). Six animals showed full recovery and 8 animals died or were euthanized. Death was associated with acute onset of ventricular tachycardia in 2 dogs, 1 dog died with non-responsive third degree AV-block, 3 dogs died after developing aspiration pneumonia, and 1 dog died of unknown causes. [source] Linear Ablation with Duty-Cycled Radiofrequency Energy at the Cavotricuspid IsthmusPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2010STEFANIE BOLL Background: Multielectrode catheters using duty-cycled radiofrequency (RF) have been developed to treat atrial fibrillation (AF). Many of these patients also have atrial flutter. Therefore, a linear multielectrode has been developed using the same RF energy. Objective: The concept and acute results of linear ablation using duty-cycled RF were tested in the cavotricuspid isthmus (CTI). Methods: The CTI was targeted in 75 patients, in 68 (90%) among them as an adjunct to AF ablation with the same technology. A linear electrode catheter with a 4-mm tip and five 2-mm ring electrodes was connected to a generator titrating duty-cycled RF at 20,45 W up to a target temperature of 70°C in 1:1 unipolar/bipolar mode. Results: During a mean procedure time of 20 ± 12 minutes, complete CTI block was achieved by 4 ± 3 applications of duty-cycled RF in 69 (92%) patients. No more than three RF applications were necessary in 60% of patients. During the initial learning curve, standard RF had to be used in five (7%) patients. Complete block was not achieved in one patient with frequent episodes of AF. Char was observed in five (7%) patients with poor electrode cooling; consequently, the temperature ramp-up was slowed and manually turned off in the event of low-power delivery. Two groin hematomas occurred; otherwise, no clinical complications were observed. Conclusion: Multielectrode catheters delivering duty-cycled RF can effectively ablate the CTI with few RF applications with promising acute results. Further modifications are necessary to improve catheter steering and prevent char formation. (PACE 2010; 444,450) [source] Thermoregulatory sympathetic nervous system activity and diet-induced waist-circumference reduction in obese Japanese womenAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2009Mami Fujibayashi The present study is designed to investigate how and to what extent sympathovagal behavior in a balanced low-calorie diet relates to favorable changes of body mass, waist circumference, and/or metabolic risk factors. The study involved 28 mildly obese women without clinical complications, who underwent an 8-week calorie restriction program using a 1,200-kcal daily diet with an adequate nutrient content; including two regular meals, and one formula meal replacement. All subjects were examined before and after the dietary intervention. We measured anthropometric parameters, blood pressure, and biochemical blood profiles for lipid metabolism. Autonomic nervous system activity was evaluated by heart rate variability power spectral analysis. The dietary intervention induced moderate, but significant reduction of waist circumference (,5.3% ± 0.8%), body fat percentage (,5.8% ± 0.8%), and body mass (,6.6% ± 0.5%). Linear regression analysis showed that ,very low frequency (VLF) power reflecting energy metabolic- and thermoregulatory sympathetic function significantly correlated to ,waist circumference (r = ,0.53, P < 0.01), ,body fat percentage (r = ,0.39, P < 0.05), ,body mass (r = ,0.43, P < 0.05), ,HDL-cholesterol/total cholesterol ratio (HDL-C/TC) (r = 0.62, P < 0.001), and ,nonesterified fatty acids (NEFA) (r = 0.56, P < 0.01). A stepwise multiple regression analysis additionally revealed that ,waist circumference (P = 0.024), ,HDL-C/TC (P = 0.013), and ,NEFA (P = 0.016) were significant and independent factors, which contributing to the variance in ,VLF power (r2 = 0.61). Although causes and consequences of obesity continue to elude researchers, the present study indicates that thermoregulatory sympathetic activity relates to moderate waist-circumference reduction together with favorable changes of blood lipid profiles after short-term dietary modification in mildly obese women. Am. J. Hum. Biol. 2009. © 2009 Wiley-Liss, Inc. [source] Proteomic analysis of human vessels: Application to atherosclerotic plaquesPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 6 2003Mari Carmen Duran Abstract Atherosclerosis is a chronic disease that affects medium and large arteries. This process originates from the interaction between cells of the arterial wall, lipoproteins and inflammatory cells, leading to the development of complex lesions or plaques that protrude into the arterial lumen. Plaque rupture and thrombosis result in acute clinical complications such as myocardial infarction and stroke. Owing to the heterogeneous cellular composition of the plaques, a proteomic analysis of the whole lesion is not appropriate. Therefore, we have studied the proteins secreted by human carotid atherosclerotic plaques, obtained by endarterectomy. Normal artery segments and different regions of the surgical pieces (noncomplicated plaque, complicated plaque with thrombus) were cultured in protein-free medium and the secreted proteins (supernatants) analyzed by two-dimensional gel electrophoresis. Normal artery segments secreted a moderate number of proteins (42 spots). However in the two-dimensional (2-D) gels (pH 3,10) of segments bearing a plaque, the number of spots increased markedly (154). The number of spots also increased (202) in the 2-D gels of artery segments with a ruptured plaque and thrombus. Thus, the more complicated the lesion, the higher the number of secreted proteins, suggesting the production of specific proteins relating to the complexity of the atherosclerotic lesion. [source] Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002BIRTH, Issue 4 2004Andrea Linton MS However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source] Clinical complications following thyroid fine-needle biopsy: a systematic reviewCLINICAL ENDOCRINOLOGY, Issue 2 2009Stergios A. Polyzos Summary Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive and generally safe diagnostic procedure in the management of thyroid nodules. Post-FNB local pain and minor haematomas are the most common complications, while serious complications seem to be rare. Given that use of FNB minimizes unnecessary surgery and subsequent operative morbidity and mortality as well as the fact that the majority of FNB complications resolve spontaneously, the overall safety of FNB is not questioned. However, awareness of the potential complications and careful estimation of the risk-benefit ratio in an individual basis may further decrease the low morbidity of FNB. In this systematic review we tried to collect and summarize all reported clinical complications following diagnostic thyroid FNB, aiming to make physicians aware of possible complications and to provide preventive measures to avoid them. [source] | ||||||||||||||||||||||