Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention

Surveillance for toxic-shock syndrome (TSS) in Wisconsin detected 38 cases with onsets from September 1975 through June 1980. Thirty-seven of the cases occurred after January 1, 1979; 37 of the patients were women, 35 cases occurred during menses; 38 patients were white; and one patient died. Cervical or vaginal cultures were obtained before antibiotic therapy in 23 patients, and 17 cultures were positive for Staphylococcus aureus. Ten patients had at least one recurrent episode during subsequent menstrual periods. The recurrence rate was lower in patients who had been treated with beta-lactamase-resistant antibiotics. Thirty-five patients were matched for age and menstruation to 105 controls: 34 of 35 cases (versus 80 of 105 controls) used tampons during every menstrual period (P < 0.01); nine of 35 cases (versus 64 of 105 controls) practiced contraception (P < 0.001). In Wisconsin the minimum incidence of TSS as defined by clinical criteria is 6.2 cases per 100,000 menstruating women per year. The rate of TSS among menstruating women younger than 30 years was 2.4 to 3.3 times the rate among those who were 30 or older.     

Lipoprotein(a) and the cardiovascular risk during estrogen-progestin replacement therapy in postmenopause

A homogeneous group of 37 patients, aged between 52 and 61 years was considered in relationship to the metabolic response during hormonal replacement therapy (HRT). A free endocrinological-metabolic pathology control group, formed by 40 patients, who were not treated with any therapy, was also considered. Study-trial was comprehensive of a 123 months follow-up, with some periods of study at 0, +6, +12 months. Metabolic responses of lipoprotein(a) and apolipoprotein A and B during the different follow-up steps were determined. Total and fractioned cholesterol and triglycerides were also determined. Significant correlations were shown between Lipo(a) and Apo B and also between Lipo(a) and LDL in both groups considered Lipoprotein(a) was determined by ELISA methodic and turbidimetric methodic. The aim of our study was to verify the importance of the new markers of the atheromatous risk. The reduction of lipoproteins middle value observed in the HRT group shows a little, but however present, estrogens action to the Lipo(a) itself. This fact testifies to the benefit of the use of HRT in post-menopause also as reg ards an evaluated cardiovascular risk inhibition.     

Soy protein, isoflavones and cardiovascular disease risk

Since the early 1940s, scientists have examined the effect of soy protein on blood cholesterol concentrations. Although studies in animals have suggested that soy protein lowers blood cholesterol concentrations, similar studies in humans have yielded less consistent results. The presence or absence of the soybean isoflavone fraction may be a confounding factor. This fraction, consisting primarily of genistein, daidzein and glycetein, has been shown to have a hypocholesterolemic effect in animals and humans. Potential mechanisms by which soy protein and/or isoflavones induce lowering of blood cholesterol concentrations include thyroid status, bile acid balance and the estrogenic effects of genistein and daidzein. Some studies have suggested that isoflavones exhibit antioxidant properties and have favorable effects on arterial compliance. In addition to the aforementioned potential beneficial effects, the increased consumption of products containing soy protein may displace foods relatively high in saturated fat and cholesterol from the diet and hence have an indirect blood cholesterol-lowering effect.     

Microalbuminuria, arterial hypertension and the cardiovascular risk

Both the Entamoeba histolytica lectin, a virulence factor for the causative agent of amebiasis, and the mammalian hepatic lectin bind to N-acetylgalactosamine (GalNAc) and galactose (Gal) nonreducing termini on oligosaccharides, with preference for GalNAc. Polyvalent GalNAc-derivatized neoglycoproteins have >1000-fold enhanced binding affinity for both lectins (Adler,P., Wood,S.J., Lee,Y.C., Lee,R.T., Petri,W.A.,Jr. and Schnaar,R.L.,1995, J. Biol. Chem ., 270, 5164-5171). Substructural specificity studies revealed that the 3-OH and 4-OH groups of GalNAc were required for binding to both lectins, whereas only the E.histolytica lectin required the 6-OH group. Whereas GalNAc binds with 4-fold lower affinity to the E.histolytica lectin than to the mammalian hepatic lectin, galactosamine and N-benzoyl galactosamine bind with higher affinity to the E. histolytica lectin. Therefore, a synthetic scheme for converting polyamine carriers to poly-N-acyl galactosamine derivatives (linked through the galactosamine primary amino group) was developed to test whether such ligands would bind the E.histolytica lectin with high specificity and high affinity. Contrary to expectations, polyvalent derivatives including GalN6lys5, GalN4desmosine, GalN4StarburstTMdendrimer, and GalN8StarburstTMdendrimer demonstrated highly enhanced binding to the mammalian hepatic lectin but little or no enhancement of binding to the E.histolytica lectin. We propose that the mammalian hepatic lectin binds with greatest affinity to GalNAc "miniclusters," which mimic branched termini of N-linked oligosaccharides, whereas the E.histolytica lectin binds most effectively to "maxiclusters," which may mimic more widely spaced GalNAc residues on intestinal mucins.     

Fibrinogen and cardiovascular risk

We trained 24 rats to perform an eight-arm radial maze task and then assigned them with a matching procedure to one of three treatments: sham surgery or lesions of the projection areas of the mediodorsal thalamic nucleus (MDn) in the medial wall (MW) or in both the MW and rhinal sulcal (RS) areas of frontal cortex. After recovery we trained the rats to perform six tasks, beginning with the standard eight-arm task, followed by two versions of a four forced choice procedure, and then three versions of a two-choice delayed-nonmatching-to-sample (DNMTS) task. The two lesion groups performed comparably on all tasks, showing that impairments were not exacerbated by extension of the MW lesion to include all cortical areas innervated by MDn. As in previous studies, frontal animals performed the radial maze task poorly immediately after surgery but improved with subsequent training. Controlling the order of the arm entries by opening the first four gates in a random sequence had little effect on performance, although frontal animals were impaired when lengthy delays (5 or 15 min) were imposed after the last of the four forced entries. Frontal animals were not impaired on two-choice DNMTS when the arms used for training were selected at random from the eight alternatives on a trial by trial basis, even when visual cues were eliminated by darkening the room and covering the maze. Frontal animals were significantly impaired when the selection of sample and choice arms was limited to the same two alternatives on every trial. This finding may explain the reported sensitivity of DNMTS to the effects of frontal lesions when training is carried out in operant chambers.     

Microalbuminuria and cardiovascular risk

As a part of long-term follow up (I) of 544 cemented Müller-curved stem total hip replacements (THR), implanted 1977 to 1983, 207 THR in 163 patients with rheumatoid arthritis (RA) were evaluated 9 to 15 years (11 on an average) postoperatively. The feed back rate was 96.9% so the results are very reliable. 18 cups were loosened (13 already changed), but no stem had to be changed for aseptic loosening. 2 THR (1.0%) had to be revised because of deep infection. Survival rate of Kaplan and Meier for aseptic loosening was 94.6% after 10 years, 83.5% after 15 years. The ARO multi-center-study 1995 (II) includes 3113 THR implanted 1987 and 1988. Within a follow-up period of 7 to 9 years the over all rate of aseptic changing for cemented cups (1.4%) was significantly lower than for uncemented cups (2.9%)--in RA even 1% versus 5.7%. The corresponding rates for stems was 1.0% (cemented) versus 1.8% (uncemented). We contributed 110 THR in 94 patients with RA with feed back of 100%. Because of deep infection one THR had to be changed and two were explanted. But no change of cup or stem because of aseptic loosening was observed. Also in the literature survival rates up to 97% after 10 years or 77% after 25 years even in younger patients with RA can be stated. CONCLUSIONS: Cemented THR shows good long-term-results in RA which with uncemented designs have also to be proved. As a consequence of analysing the (few) failures the cemented THR of Wessinghage with optimized bone-cement-implant-compound was introduced. We demand a high feed back rate in long-term follow-ups also with respect to quality management and comparing data.     

Hypertension, admission blood pressure and perioperative cardiovascular risk

We performed a retrospective case-control study to investigate hypertension and admission blood pressure as risk factors for postoperative cardiovascular death. We identified records of 76 patients who had died of a cardiovascular cause within 30 days of anaesthesia and elective surgery and 76 matched controls. From the records of each patient (case and control) we recorded the admission blood pressure and details of any history of hypertension. A pre-operative history of hypertension was strongly associated with perioperative cardiovascular death (p < 0.001 with one degree of freedom: odds ratio 4.14, 95% confidence intervals 1.63-11.69). There was no association between systolic or diastolic pressure at admission for operation and perioperative cardiovascular death. The mean admission systolic pressure of the cases was 145.5 mmHg (range 90-250 mmHg) and that of the controls was 146.5 mmHg (range 100-200 mmHg). The mean admission diastolic pressure of the cases was 83.2 mmHg (range 60-130 mmHg), and that of the controls was 84.5 mmHg (range 60-110 mmHg).     

Review of epidemiologic evidence on benzene and lymphatic and hematopoietic cancers

In the search for explanation of persistent cognitive impairment associated with alcohol dependence, the possible role of liver disease has aroused considerable interest. However, review of the relevant literature provides only ambiguous support for any general relationship between neuropsychological status and laboratory tests of liver function. We tested the general hypothesis, and also two specific hypotheses relating particular liver function parameters (gamma-glutamyl transferase and serum albumin) to mental ability in a sample of 54 recently detoxified alcohol-dependent people. Despite adequate design power, we failed to obtain evidence for general or specific correlations between mental ability and liver function. We conclude that the accumulated data do not provide direct support for the hypothesis that liver disease plays a part in the genesis of chronic alcohol-related brain impairment in clients without cirrhosis.     

p53 in node-negative breast carcinoma: an immunohistochemical study of epidemiologic risk factors, histologic features, and prognosis

PURPOSE: The present study explores p53 in relation to the following four aspects of node-negative breast carcinoma: epidemiologic risk factors, tumor histopathology, prognosis, and HER2/neu (HER) expression. MATERIALS AND METHODS: Immunohistochemical (IH) staining for p53 was performed on formaldehyde-fixed, paraffin-embedded primary invasive carcinomas from 440 node-negative patients with a median follow-up duration of 119 months. RESULTS: The IH expression, or lack thereof, of p53 separately or in combination with HER did not prove to be prognostically significant and there was no consistent association of p53 with epidemiologic risk factors. p53 was expressed in 68% of medullary carcinomas (MEDs), which is a significantly higher frequency (P < .001) than in lobular (9%) and duct (23%) carcinomas. p53 was not found in some types of low-grade carcinomas (tubular and papillary), and was observed in a minority of mucinous carcinomas. p53 was present significantly more often in carcinomas with high-grade or poorly differentiated nuclear grade than in low- or intermediate-grade tumors. There was an inverse statistically significant relationship between estrogen receptor (ER) positivity and p53 expression. Tumors with the p53(+)/HER(-) immunophenotype tended to be MEDs or duct carcinomas with a marked lymphoplasmacytic reaction. Infiltrating lobular carcinomas (IFLCs) were largely p53(-)/HER(-). p53(+)/HER(+) carcinomas had the best prognosis. The poorest outcome was associated with the p53(-)/HER(+) immunophenotype. This trend was statistically significant for recurrence-free and overall survival in patients with T1NOMO infiltrating duct carcinoma (IFDC). CONCLUSION: The IH demonstration of p53 was not a reliable prognostic indicator in the node-negative breast carcinoma patients studied and it was not associated with major epidemiologic risk factors. The combined immunophenotypic expression of p53 and HER was significantly associated with some histologic types of breast carcinoma and with prognosis in T1NOMO breast carcinoma.     

Carcinogenic effects of diesel emissions and lung cancer: the epidemiologic evidence is not causal

The effects of diesel engine exhaust in lung carcinogenesis have been evaluated by several scientific organizations and government agencies. This complex issue has required a multidisciplinary approach including atmospheric measurements, toxicology, chemical carcinogenesis, epidemiology, and risk assessment. One important aspect of the epidemiological studies that deserves further attention is the confounding effects of cigarette smoking. Only some epidemiological studies have statistically adjusted for cigarette smoking, usually by years of smoking, cigarettes per day, or pack-years. Some studies obtained smoking information from proxy interviews. However, differences in "tar" intake, interpuff interval, depth of inhalation, and other smoking behavior patterns were not evaluated. These smoking parameters are rarely collected for occupational data analysis, yet the inability to adjust statistically for such parameters may result in a small degree of residual confounding. Because the highest odds ratios for lung cancer associated with diesel engine exhaust are usually less than 2 or 1.5, possible residual confounding effects of smoking may have resulted in spurious associations.     

PAI-1, obesity, insulin resistance and risk of cardiovascular events

Circulating (PAI-1) levels are elevated in patients with coronary heart disease and may play an important role in the development of atherothrombosis. Many clinical studies have indicated that the insulin resistance syndrome, which is a situation predisposing to diabetes and ischemic heart disease, may be a major regulator of PAI-1 expression, especially in determining plasma PAI-1 levels. Central obesity is a characteristic of insulin resistance and is a well recognized risk factor for coronary heart disease. Recently the production of PAI-1 by adipose tissue, in particular by tissue from omentum, has been demonstrated and could be an important contributor to the elevated plasma PAI-1 levels observed in insulin resistant patients. Besides the effect of the metabolic status on plasma PAI-1 levels, the role of a genetic control has been emphasized, but according to recent results obtained in a family segregation study, its participation seems limited. Prospective cohort studies of patients with previous myocardial infarction or angina pectoris have underlined the association between increased plasma PAI-1 levels and the risk of coronary events, but the predictive capacity of PAI-1 disappears after insulin resistance marker adjustments. Taken together these results support the notion that PAI-1 can be a link between obesity, insulin resistance and cardiovascular disease.     

Familial correlations, cohabitation effects, and heritability for cardiovascular risk factors

The phosphorylation of the sarcoplasmic reticulum Ca-ATPase (EC 3.6.1.38) with P(i) was characterized using Mn as a Mg analogue. Steady state and transient fluorescence and radioisotopic techniques were used; the affinities of Mn and P(i) for the enzyme and the rate constants of the phosphorylation and dephosphorylation reactions were determined, under several conditions. The reactions were carried out at pH 5.5 to minimize the binding of contaminant Ca to the transport sites, thus avoiding the use of Ca chelators. The apparent affinity of Mn binding at low [Mn] is larger in the absence of P(i) (35 microM) than in the presence of saturating P(i) (70 microM). On the contrary, the apparent affinity of Mn for the formation of the phosphoenzyme increases, from 1.5 mM to 0.15 mM, upon increasing [P(i)] in the millimolar range. The apparent affinty of P(i) for the formation of the phosphoenzyme also increases, from 2.2 mM to 0.2 mM, upon increasing [Mn] in the millimolar range. The equilibrium of the phosphoenzyme with the noncovalent Mn.P(i). Enzyme complex favors the covalent species. The simulation of a reaction model including the random binding of 2 Mn and I P(i) per mol of ATPase and a noncovalent complex in equilibrium with the phosphoenzyme, using a set of equilibrium constants deduced from the results, agree with the experimental data.     

Serum calcium, magnesium, copper and zinc and risk of cardiovascular death

OBJECTIVE: To study the association of serum calcium, magnesium, copper and zinc concentrations with cardiovascular mortality. DESIGN: A nested case-control study within a prospective population study. SUBJECTS AND METHODS: 230 men dying from cardiovascular diseases and 298 controls matched for age, place of residence, smoking and follow-up time. Mean follow-up time was 10 years. Serum calcium, magnesium, copper and zinc concentrations were determined from samples kept frozen at -20 degrees C. RESULTS: High serum copper and low serum zinc concentrations were significantly associated with an increased mortality from all cardiovascular diseases and from coronary heart disease in particular. The relative risk of coronary heart disease mortality between the highest and lowest tertiles of serum copper and zinc were 2.86 (P = 0.03) and 0.69 (P = 0.04), respectively. Adjustment for social class, serum cholesterol, body mass index, hypertension and known heart disease at baseline examination did not materially alter the results. No significant differences were observed in concentrations of serum calcium and magnesium between cases and controls. CONCLUSIONS: High serum copper and low serum zinc are associated with increased cardiovascular mortality whereas no association was found with serum calcium and magnesium and mortality risk.