[Comparison of the functional outcomes of patients with arthroscopic repair of massive rotator cuff ruptures alone or combined with acromioplasty or biceps tenotomy]. / Comparación de los resultados funcionales de los pacientes con reparación artroscópica de rupturas masivas del manguito rotador sola o combinada con acromioplastía y/o tenotomía del bíceps.

BACKGROUND: The rotator cuff injury it is one of the most common causes of pain and functional disability of the shoulder with an annual reported incidence of 4.5 million cases in the United States. It is one of the leading causes of pain of shoulder in patients older than 60 years. In Mexico, there are no reports of the incidence or the results of arthroscopic repair of massive rotator cuff lesions alone or combined with other procedures. OBJECTIVE: To evaluate the clinical evolution of patients post-surgery of arthroscopic rotator cuff massive injury repair AR-RCMI alone or in combination with other techniques. METHODS: Evaluation of records of patients with AR-RCMI post-surgery, comparing the results of the scales: simple shoulder test and VAS before and after surgery with a follow up of 2.6 years. The combined procedures were acromioplasty, tenotomy of biceps or both. RESULTS: 65 patients with diagnosis of massive injury; with an average age of 62.8 years (SD ± 9. 42), 27.7% were men and 72.3% women. The evaluation was conducted in four groups: arthroscopic repair (AR); arthroscopic repair + biceps tenotomy (AR + BT); arthroscopic repair + acromioplasty (AR + A) and arthroscopic repair + biceps tenotomy + acromioplasty (AR + BTA). All groups showed significant reduction in pain: AR (-44.1%, p = 0.0001), AR + A (-36.9%, p = 0.001), AR + BT (-36.3%, p = 0.0001), AR + BT + A (-38.5%, p = 0.0001). All groups had significant improvement in function with the SST scale.

ANTECEDENTES: La lesión del manguito rotador (LMR) es una de las causas más comunes de dolor y discapacidad funcional del hombro con una incidencia anual reportada de 4.5 millones de casos en Estados Unidos. La LMR es una de las principales causas de dolor de hombro en pacientes mayores de 60 años. En México, no existen reportes de la incidencia ni de los resultados de la reparación artroscópica de las lesiones masivas de manguito rotador sola o combinada con otros procedimientos. OBJETIVO: Evaluar la evolución clínica de los pacientes postoperados de reparación artroscópica de lesión masiva del manguito rotador (RA-LMMR), sola o combinada con otras técnicas. MÉTODOS: Evaluación de expedientes de pacientes postoperados de RA-LMMR en la que se compararon los resultados de las escalas: simple shoulder test y EVA antes y después de la cirugía a un seguimiento promedio de 2.6 años. Los procedimientos combinados fueron acromioplastía, tenotomía de bíceps o ambas. RESULTADOS: 65 pacientes con diagnóstico de lesión masiva con edad promedio de 62.8 años (DE ± 9.42), 27.7% fueron hombres y 72.3% mujeres. La evaluación se realizó en cuatro grupos: reparación artroscópica (RA), reparación artroscópica + tenotomía del bíceps (RA + TB), reparación artroscópica + acromioplastía (RA + A) y reparación artroscópica + tenotomía del bíceps + acromioplastía (RA + TBA). Todos los grupos mostraron disminución significativa del dolor: RA (-44.1%, p = 0.0001), RA + A (-36.9%, p = 0.001), RA + TB (-36.3%, p = 0.0001), RA + TB + A (-38.5%, p = 0.0001). De igual forma todos los grupos mostraron mejoría significativa de la función evaluada con la escala SST.

Comparación de los resultados funcionales de los pacientes con reparación artroscópica de rupturas masivas del manguito rotador sola o combinada con acromioplastía y/o tenotomía del bíceps / Comparison of the functional outcomes of patients with arthroscopic repair of massive rotator cuff ruptures alone or combined with acromioplasty or biceps tenotomy

Resumen: Antecedentes: La lesión del manguito rotador (LMR) es una de las causas más comunes de dolor y discapacidad funcional del hombro con una incidencia anual reportada de 4.5 millones de casos en Estados Unidos. La LMR es una de las principales causas de dolor de hombro en pacientes mayores de 60 años. En México, no existen reportes de la incidencia ni de los resultados de la reparación artroscópica de las lesiones masivas de manguito rotador sola o combinada con otros procedimientos. Objetivo: Evaluar la evolución clínica de los pacientes postoperados de reparación artroscópica de lesión masiva del manguito rotador (RA-LMMR), sola o combinada con otras técnicas. Métodos: Evaluación de expedientes de pacientes postoperados de RA-LMMR en la que se compararon los resultados de las escalas: simple shoulder test y EVA antes y después de la cirugía a un seguimiento promedio de 2.6 años. Los procedimientos combinados fueron acromioplastía, tenotomía de bíceps o ambas. Resultados: 65 pacientes con diagnóstico de lesión masiva con edad promedio de 62.8 años (DE ± 9.42), 27.7% fueron hombres y 72.3% mujeres. La evaluación se realizó en cuatro grupos: reparación artroscópica (RA), reparación artroscópica + tenotomía del bíceps (RA + TB), reparación artroscópica + acromioplastía (RA + A) y reparación artroscópica + tenotomía del bíceps + acromioplastía (RA + TBA). Todos los grupos mostraron disminución significativa del dolor: RA (-44.1%, p = 0.0001), RA + A (-36.9%, p = 0.001), RA + TB (-36.3%, p = 0.0001), RA + TB + A (-38.5%, p = 0.0001). De igual forma todos los grupos mostraron mejoría significativa de la función evaluada con la escala SST.

Abstract: Background: The rotator cuff injury it is one of the most common causes of pain and functional disability of the shoulder with an annual reported incidence of 4.5 million cases in the United States. It is one of the leading causes of pain of shoulder in patients older than 60 years. In Mexico, there are no reports of the incidence or the results of arthroscopic repair of massive rotator cuff lesions alone or combined with other procedures. Objective: To evaluate the clinical evolution of patients post-surgery of arthroscopic rotator cuff massive injury repair AR-RCMI alone or in combination with other techniques. Methods: Evaluation of records of patients with AR-RCMI post-surgery, comparing the results of the scales: simple shoulder test and VAS before and after surgery with a follow up of 2.6 years. The combined procedures were acromioplasty, tenotomy of biceps or both. Results: 65 patients with diagnosis of massive injury; with an average age of 62.8 years (SD ± 9. 42), 27.7% were men and 72.3% women. The evaluation was conducted in four groups: arthroscopic repair (AR); arthroscopic repair + biceps tenotomy (AR + BT); arthroscopic repair + acromioplasty (AR + A) and arthroscopic repair + biceps tenotomy + acromioplasty (AR + BTA). All groups showed significant reduction in pain: AR (-44.1%, p = 0.0001), AR + A (-36.9%, p = 0.001), AR + BT (-36.3%, p = 0.0001), AR + BT + A (-38.5%, p = 0.0001). All groups had significant improvement in function with the SST scale.

The postprandial inflammatory response after ingestion of heated oils in obese persons is reduced by the presence of phenol compounds.

SCOPE: Heating during the process of cooking alters the chemical properties of foods and may affect subsequent postprandial inflammation. We tested the effects of four meals rich in different oils subjected to heating on the postprandial inflammatory metabolism of peripheral blood mononuclear cells (PBMCs). METHODS AND RESULTS: Twenty obese participants received four breakfasts following a randomized crossover design, consisting of milk and muffins made with different oils (virgin olive oil (VOO), sunflower oil (SFO), and a mixture of seeds oil (SFO/canola oil) with added either dimethylpolysiloxane (SOD), or natural antioxidants from olive mill wastewater alperujo (phenols; SOP)), previously subjected to 20 heating cycles. Postprandial inflammatory status in PBMCs was assessed by the activation of nuclear NF-κB, the concentration in cytoplasm of the NF-κB inhibitor (IκB-α), the mRNA levels of NF-κB subunits and activators (p65, IKKß, and IKKα) and other inflammatory molecules (TNF-α, IL-1ß, IL-6, MIF, and JNK), and lipopolysaccharide (LPS) levels. VOO and SOP breakfasts reduced NF-κB activation, increased IκB-α, and decreased LPS plasma concentration. SFO increased IKKα, IKKß, p65, IL-1b, IL-6, MIF, and JNK mRNA levels, and plasma LPS. CONCLUSION: Oils rich in phenols, whether natural (VOO) or artificially added (SOP), reduce postprandial inflammation, compared with seed oil (sunflower).

Polymorphism at the TRIB1 gene modulates plasma lipid levels: insight from the Spanish familial hypercholesterolemia cohort study.

BACKGROUND AND AIMS: rs17321515 SNP has been associated with variation in LDL-C, high density lipoprotein cholesterol and triglycerides concentrations. This effect has never been studied in patients with severe hypercholesterolemia. Therefore, our aims were to assess the association of the rs17321515 (TRIB1) SNP with plasma lipids concentrations and anthropometric variables and to explore the interaction between this SNP and some classic risk factors in patients with familial hypercholesterolemia (FH). METHODS AND RESULTS: rs17321515 SNP was genotyped in 531 subjects with genetic diagnosis of FH. Homozygous A/A had significantly higher waist circumference compared with G/G subjects (P = 0.006) and carriers of the minor allele G (P = 0.039). Interestingly, smokers homozygous for the A allele displayed higher plasma triglycerides concentrations (P = 0.029), higher VLDL-C levels (P = 0.023) and higher TC/HDL-C ratio (P = 0.035) than carriers of the minor allele G. In addition, homozygous A/A with the presence of arcus cornealis displayed lower plasma ApoA-I levels (P = 0.024) and higher TC/HDL-C ratio (P = 0.046) than carriers of the minor allele G. CONCLUSIONS: Smoking status and presence of arcus cornealis modulate the effect of rs17321515 (TRIB1) polymorphism on plasma lipids levels in patients with FH. These results could explain the differences in the susceptibility to coronary heart disease in these patients.

Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).

Genetic variations at ABCG5/G8 genes modulate plasma lipids concentrations in patients with familial hypercholesterolemia.

OBJECTIVE: To investigate the association of four common single nucleotide polymorphisms (SNPs) at ABCG5 (i7892A>G, i18429C>T, Gln604GluC>G, i11836G>A) and five at ABCG8 (5U145T>G, Tyr54CysA>G, Asp19HisG>C, i14222T>C, and Thr400LysG>T) with plasma lipids concentrations and to explore the interaction between those SNPs and smoking in patients with FH. METHODS AND RESULTS: ABCG5/G8 SNPs were genotyped in 500 subjects with genetic diagnosis of FH. Carriers of the minor A allele at the ABCG5_i11836G>A SNP displayed significantly higher HDL-C concentrations (P=0.023) than G/G subjects. In addition, carriers of the minor G allele at the ABCG5_Gln604GluC>G SNP had significantly lower VLDL-C (P=0.011) and lower TG (P=0.017) concentrations than homozygous C/C. Interestingly, a significant gene-smoking interaction was found, in which carriers of the minor alleles at ABCG5 (i7892A>G, i18429C>T, i11836G>A) SNPs displayed significantly lower HDL-C, higher TC and higher TG respectively, only in smokers. On the other hand, nonsmokers carriers of the minor alleles at ABCG5 (i18429C>T and Gln604GluC>G) SNPs had significantly lower TG concentrations (P=0.012 and P=0.035) compared with homozygous for the major allele. CONCLUSIONS: Our data support the notion that ABCG5/G8 genetic variants modulate plasma lipids concentrations in patients with FH and confirm that this effect could be influenced by smoking. Therefore, these results suggest that gene-environmental interactions can affect the clinical phenotype of FH.

Chronic effects of a high-fat diet enriched with virgin olive oil and a low-fat diet enriched with alpha-linolenic acid on postprandial endothelial function in healthy men.

Traditional cardiovascular risk factors are associated with endothelial dysfunction. The vascular endothelium plays a key role in local vascular tone regulation and can be modulated by dietary fat. We propose to determine the chronic effect of three diets with different fat compositions on postprandial endothelial function and inflammatory biomarkers. Twenty healthy men followed three 4-week diets in a randomised cross-over design: a Western diet, rich in saturated fat (22% SFA, 12% MUFA and 0.4% alpha-linolenic acid (ALA), all fractions are % of energy); a Mediterranean diet, rich in MUFA ( < 10 % SFA, 24 % MUFA and 0.4% ALA); a low-fat diet enriched in ALA ( < 10% SFA, 12% MUFA and 2% ALA). At the end of each dietary period all subjects underwent a postprandial study. Plasma concentrations of lipid parameters, soluble intercellular cell-adhesion molecule-1, soluble vascular cell-adhesion molecule-1 (sVCAM-1), nitrates and nitrites (NOx) and endothelial function studied by laser Doppler were examined at 0, 2, 4, 6 and 8 h. The endothelium-dependent vasodilatory response was greater 4 h after the ingestion of the MUFA-rich diet than after the SFA or ALA low-fat diets (P = 0.031). The 4 h postprandial plasma sVCAM-1 levels were lower after the MUFA meals than after the ALA low-fat diet (P = 0.043). The bioavailability of NOx was higher following the MUFA diet than after the SFA and ALA low-fat diets (P = 0.027). We found no differences in the other parameters measured. Chronic ingestion of a Mediterranean diet avoids the postprandial deterioration of endothelial function associated with Westernised diets in healthy individuals.

Basal plasma concentrations of plant sterols can predict LDL-C response to sitosterol in patients with familial hypercholesterolemia.

BACKGROUND: Familial hypercholesterolemia (FH) is associated with a high risk of coronary heart disease. Pharmacological treatment and diet are both essential for the management of FH. Foods rich in plant sterols (PS) may play an important role in the treatment of patients with these disorders. OBJECTIVE: To test the effect of the intake of PS on low-density lipoprotein (LDL) concentration, endothelial function (EF) and LDL particle size in 30 patients with FH. DESIGN: Randomized and crossover dietary intervention study. SETTING: Tertiary outpatient care. SUBJECTS: Thirty-eight were recruited, but only 30 were subjected to four low-fat dietary intervention periods, each of 4 weeks. METHODS: Each intervention had a different content of cholesterol (<150 or 300 mg/day) and sitosterol (<1 or 2 g/day). Lipid response, EF and LDL particle size were analysed after the intervention. RESULTS: Plasma sitosterol/cholesterol ratio was higher during both plant sterol-rich periods than during the low plant sterols periods. Basal sitosterol concentrations predicted the LDL-cholesterol response during the intake of plant sterol-enriched diets. The change in LDL-cholesterol was significantly greater in subjects in the upper and intermediate tertiles of basal plasma sitosterol concentrations (-21+/-8 mg/dl, P=0.03; -19+/-7 mg/dl, P=0.04, respectively) than in subjects in the lower tertile (8+/-5 mg/dl) when they changed from a low cholesterol diet to a low cholesterol plus plant sterol diet. CONCLUSION: Our study demonstrates that basal sitosterol values can predict hypolipidemic response in patients with FH.

International conference on the healthy effect of virgin olive oil.

1. Ageing represents a great concern in developed countries because the number of people involved and the pathologies related with it, like atherosclerosis, morbus Parkinson, Alzheimer's disease, vascular dementia, cognitive decline, diabetes and cancer. 2. Epidemiological studies suggest that a Mediterranean diet (which is rich in virgin olive oil) decreases the risk of cardiovascular disease. 3. The Mediterranean diet, rich in virgin olive oil, improves the major risk factors for cardiovascular disease, such as the lipoprotein profile, blood pressure, glucose metabolism and antithrombotic profile. Endothelial function, inflammation and oxidative stress are also positively modulated. Some of these effects are attributed to minor components of virgin olive oil. Therefore, the definition of the Mediterranean diet should include virgin olive oil. 4. Different observational studies conducted in humans have shown that the intake of monounsaturated fat may be protective against age-related cognitive decline and Alzheimer's disease. 5. Microconstituents from virgin olive oil are bioavailable in humans and have shown antioxidant properties and capacity to improve endothelial function. Furthermore they are also able to modify the haemostasis, showing antithrombotic properties. 6. In countries where the populations fulfilled a typical Mediterranean diet, such as Spain, Greece and Italy, where virgin olive oil is the principal source of fat, cancer incidence rates are lower than in northern European countries. 7. The protective effect of virgin olive oil can be most important in the first decades of life, which suggests that the dietetic benefit of virgin olive oil intake should be initiated before puberty, and maintained through life. 8. The more recent studies consistently support that the Mediterranean diet, based in virgin olive oil, is compatible with a healthier ageing and increased longevity. However, despite the significant advances of the recent years, the final proof about the specific mechanisms and contributing role of the different components of virgin olive oil to its beneficial effects requires further investigations.

Interaction between smoking and the Sstl polymorphism of the apo C-III gene determines plasma lipid response to diet.

BACKGROUND: It has recently been demonstrated that the lipid profile of smokers improves if they follow a Mediterranean diet. AIM: To establish whether the Sstl polymorphism of the apo C-III gene interacts with smoking and determines the lipid response to diet in healthy subjects. METHODS AND RESULTS: Fifty-nine volunteers (18 smokers: 8 with the S1S1 genotype, and 10 with the S2 allele; 41 non-smokers: 29 with the S1S1 genotype and 12 with the S1S2 genotype) consecutively followed three different diets: a diet enriched in saturated fatty acids (SFA) (38% fat, 20% SFA) followed by a randomised, cross-over period during which they ate a diet enriched in carbohydrates (NCEP-1) (30% fat, 10% SFA, 55% carbohydrates) and a diet enriched in monounsaturated fatty acids (MUFA) (8% fat, 22% MUFA). Cholesterol, triacylglycerol, LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) levels were measured at the end of each dietary period. The smokers carrying the S1S1 genotype were not influenced by any of the diets, but the atherogenic ratio decreased in the carriers of the S2 allele when they changed from the diet rich in SFA to a diet rich in olive oil or carbohydrates (p < 0.039). No significant difference was observed when the non-smoking carriers of the S2 allele changed from one diet to another, but there was a decrease in the LDL-C/HDL-C ratio when the subjects with the S1S1 genotype changed from the saturated diet to either of the other diets (p < 0.001). CONCLUSIONS: Smoking interacts with the apo CM polymorphism and determines the level of lipid response to dietary changes.

[Recommendations for the control of cholesterolemia in Spain]. / Recomendaciones para el control de la colesterolemia en España.

A number of recommendations are provided regarding the detection, assessment and management in primary and secondary prevention, approaching hypercholesterolaemia from a multifactorial standpoint based on cardiovascular risk. Cardiovascular diseases are the leading cause of death in Spain. The major risks involved are coronary heart disease and cerebrovascular disease. The demographic, health-related and social impact thereof will be increasing over the coming decades. Controlling hypercholesterolaemia, in conjunction with eradicating the smoking habit and controlling hypertension, diabetes, obesity and physical inactivity comprise one of the main strategies for preventing cardiovascular diseases. Breaking down the risk of individuals based on the major cardiovascular risk factors is essential, given that these factors condition the frequency with which these individuals must be monitored and the type and degree of treatment entailed. Based on this breakdown, the priorities have been set for taking steps to prevent cardiovascular disease. In primary prevention, the therapeutic objective in high-risk persons (20% risk or higher or those persons involving two or more risk factors) has been established as LDL-cholesterol < 130 mg/dl. In secondary prevention, drug treatment is indicated when LDL-cholesterol (130 mg/dl and the therapeutic objective is LDL-cholesterol < 100 mg/dl. Those patients having coronary heart disease must be included in secondary prevention programs that will ensure good, constant clinical and risk factor-related control.

[Clinical manifestations of familial hypercholesterolemia in Mediterranean population]. / Manifestaciones clínicas de la hipercolesterolemia familiar en una población mediterránea.

BACKGROUND: Familial hypercholesterolemia is defined by a genetically elevated concentration of plasma cholesterol. This is a descriptive and retrospective study to evaluate the prevalence of clinical manifestations of FH clinically diagnosed in our setting. PATIENTS AND METHODS: 114 non-related patients, from lipid clinics, entered into the study. Analytical criteria were total cholesterol over 7.8 mmol/l (300 mg/dl), triglycerides under 2.8 mmol/l (250 mg/dl), and at least one first-degree relative bearing the same lipid profile. Clinical history, antropometric measurements, lipid deposits and profile, treatment and its effects on lipid levels were recorded. Lipoprotein (a) concentration, apolipoprotein E (apo E) genotype and the presence of apo B-3500 mutations were analysed. RESULTS: Mean total cholesterol was 9.05 (1.58) mmol/l, LDL-cholesterol 7.09 (1.64) mmol/l, HDL-cholesterol 1.33 (0.45) mmol/l and triglyceride 1.38 (0.59) mmol/l. Xanthomas were found in 11.4% of the participants, 12.2% showed xanthelasmas and corneal arch was present in 27.1% of them. The 16.8% of the patients were suffering from ischaemic cardiopathy. Patients with corneal arch had higher concentrations of total and LDL-cholesterol (7.6 [1.9] vs 6.8 [1.5] mmol/l [p = 0.04]). A 57.9% of the patients with ischaemic heart disease had at least one first degree relative with the same complaint (p < 0.05). The apo B-3500 mutation was not found in this population. The apo E3/E4 genotype was present in 16.1% of the patients and total and LDL cholesterol concentrations were higher in them than in patients with the apo E3/E3 genotype (p < 0.05). In the multivariate analysis, the most important risk factors associated with ischaemic cardiopathy were the smoking habit (odds ratio [OR] = 20.59; CI: 3.3-111.2), corneal arch (OR = 7.27; 95% CI: 1.08-27.1). HDL-cholesterol concentrations were negatively associated with the existence of ischaemic heart disease (OR = 0.21; 95% CI: 0.03-1.15). CONCLUSIONS: The presence of ischaemic heart disease and lipids deposits in clinically diagnosed patients of familial hypercholesterolemia in our country is lower than description from others non Mediterranean, being the corneal arch the most prevalent sign. The smoking habit, corneal arch and the presence of familial antecessors with ischaemic heart disease were associated with ischaemic myocardiopathy in our patients.

[The Mediterranean diet improves the profile of male smokers compared with the diet recommended by the American Cholesterol Program (NCEP-I)]. / La dieta mediterránea mejora el perfil lipídico en los varones fumadores en comparación con la dieta recomendada por el Programa Americano de Colesterol (NCEP-I).

BACKGROUND: A study of the effect of smokers' diets on their atherogenic lipidic profile. SUBJECTS AND METHODS: 41 healthy males (32 non-smokers and 9 smokers) consumed consecutively a diet low in fat and rich in carbohydrates (28% total fat content < 10% saturated fats, and 57% carbohydrates), and a diet rich in monounsaturated fatty acids (38% total fat content with 22% monounsaturated fats). At the end of each dietary period, adhesion was confirmed by quantification of LDL cholesterol esters, plasma lipids and insulin levels. RESULTS: There were no significant differences between the age or the body mass of the groups of smokers or non-smokers. After both diets tobacco was found to have a significant effect on triglyceride levels (p < 0.0007), HDLc (p < 0.007), apo A-I (p < 0.02) and the LDLc/HDLc ratio (p < 0.005), revealing an interaction between diet and both HDLc levels (p < 0.004) and LDLc/HDLc ratios (p < 0.003). With the low fat and high monounsaturated fatty acid content diets smokers presented higher triglyceride levels (both with p < 0.0002) and LDLc/HDLc ratios (p < 0.0002 and p < 0.05, respectively) and lower levels of apo A-I (p < 0.002 and p < 0.004, respectively). However, in smokers the HDLc levels were only reduced after the low fat diet (p < 0.0003) and after the diet with a high monounsaturated fat content there was a rise in HDLc levels (p < 0.02) and a drop in the LDLc/HDLc ratio (p < 0.005) compared to the group of non-smokers. There were no significant differences in the insulin levels between groups. CONCLUSION: The atherogenic lipidic profile of smokers is due to an effect of tobacco on the lipidic metabolism. This atherogenic profile is accentuated with a low fat diet rich in carbohydrates and can be rectified to some degree with a diet with a high monounsaturated fatty acid content.

Effects of different dietary cholesterol concentrations on lipoprotein plasma concentrations and on cholesterol efflux from Fu5AH cells.

BACKGROUND: The fatty acid composition of the diet can modulate the effect of dietary cholesterol on plasma lipoproteins. However, HDL composition and its capacity to promote cholesterol efflux can be influenced by the diet. OBJECTIVE: Modifications in plasma lipids and in the capacity of serum to stimulate the cholesterol efflux induced by a low-fat diet [National Cholesterol Education Program (NCEP) Step I diet], by a monounsaturated fatty acid (MUFA)-rich diet, and by addition of cholesterol to both diets was studied. DESIGN: Fifteen young, healthy men followed 2 NCEP Step I diets (<30% of fat as energy, with <10% saturated fat and 14% MUFAs) for 24 d, providing 0.027 or 0.068 mg cholesterol x kJ(-1) x d(-1), and 2 oleic acid-enriched diets (38% of energy as fat, with 24% MUFAs) providing the same amount of dietary cholesterol as the NCEP Step I diets. RESULTS: Total cholesterol, LDL cholesterol, apolipoprotein (apo) B, and apo A-I concentrations decreased after the NCEP Step I and MUFA diets compared with the usual diet. HDL cholesterol also decreased after the NCEP Step I diet. Total:HDL cholesterol, apo B, and apo B:apo A-I were lower after the MUFA diets than after the NCEP Step I diets. There were no significant differences between the lipid profiles obtained after the NCEP Step I and MUFA diets were enriched with cholesterol. The capacity of serum to promote cholesterol efflux was significantly higher after the cholesterol-enriched NCEP Step I diet than after the NCEP Step I diet. CONCLUSIONS: The MUFA diet induced a better lipid profile than the NCEP Step I diet; however, the increase in the cholesterol content of both diets produced similar plasma lipid changes. The cholesterol in the NCEP Step I diet increased the cholesterol efflux induced by total serum.

Human apolipoprotein A-I gene promoter mutation influences plasma low density lipoprotein cholesterol response to dietary fat saturation.

Previous studies have shown that the A to G transition occurring at position -75 bp upstream of the transcriptional start site in the human apolipoprotein A-I gene may affect plasma high density lipoprotein cholesterol (HDL-C) levels and low density lipoprotein cholesterol (LDL-C) response to changes in amount of dietary fat. We have examined the response to dietary fat saturation as a function of this mutation in 50 men and women. Subjects were first fed a saturated (SAT) fat diet (35% fat, 17% SAT) for 28 days, followed by a diet rich in monounsaturated fatty (MUFA) acids (35% fat, 22% MUFA) for 35 days and a diet rich in polyunsaturated (PUFA) fat (35% fat, 13% PUFA) for 35 days. All meals were prepared and consumed at the study sites. Lipoproteins were measured at the end of each diet period. The allele frequency for the A allele was 0.13. Subjects carrying the A allele had higher plasma cholesterol, LDL-C and triglyceride levels than those homozygotes for the G allele. As compared to the SAT diet, a PUFA diet induced significantly greater plasma total (P = 0.003) and LDL-C decreases (P = 0.001) in G/A women (-1.62 and -1.32 mmol/l, respectively) than in G/G subjects (-0.87 and -0.74 mmol/l for plasma and LDL-C, respectively). Multiple regression analysis demonstrated that in women, the variability in LDL-C response from a diet rich in SAT fat to a diet rich in PUFA was primarily due to LDL-C levels (during the SAT phase), accounting for 55.1% of the variance, waist to hip ratio (W/H; 11.4%) and the G/A polymorphism (10%). Whereas in men the major determinant of this response was smoking (21.4%). In conclusion, the G/A polymorphism appears to have a small but significant effect on plasma LDL-C responsiveness to changes in dietary fat saturation specially in women.

Composition of human VLDL triacylglycerols after ingestion of olive oil and high oleic sunflower oil.

This work was undertaken to determine the effect of diets enriched with olive oil or high oleic sunflower oil on very low density lipoprotein (VLDL) triacylglycerol composition of healthy human subjects. Both oils contain a similar proportion of monounsaturated fatty acids (MUFA) but differ in their triacylglycerol composition. All 22 human subjects initially consumed a low fat, high carbohydrate diet as recommended by the National Cholesterol Education Program (NCEP-I). They then consumed the two experimental oils (40% dietary energy) in a crossover design. The olive oil and high oleic sunflower oil diets resulted in significant increases in palmitoleic (55%, P < 0.05), oleic (27%, P < 0.01) and eicosenoic (>100%, P < 0.001) acids of VLDL triacylglycerols, whereas there was a significant decrease in linoleic acid (38%, P < 0.001). In addition, the high oleic sunflower oil diet increased the content of stearic acid (60%, P < 0.05) and total saturated fatty acids (14%, P < 0.05). Both MUFA-rich diets significantly (P < 0.01) decreased the content of sn-glycerol-palmitate-linoleate-oleate, sn-glycerol-palmitoleate-dioleate and sn-glycerol-palmitate-dilinoleate in VLDL with regard to the NCEP-I diet, whereas they increased the content of sn-glycerol-trioleate (>100%, P < 0.001 after the olive oil diet; 80%, P < 0.05 after the high oleic sunflower oil diet). Intake of olive oil, in particular, significantly decreased the content of sn-glycerol-tripalmitate (36%, P < 0.01) and increased the content of dioleoyl-containing triacylglycerols. MUFA (P < 0.01) and arachidonic acid (P < 0.001) tended to be rich in the sn-2 position of VLDL triacylglycerols during the periods of consuming the olive oil or high oleic sunflower oil diets. In addition, olive oil, but not high oleic sunflower oil, further contributed to VLDL triacylglycerols that contained alpha-linolenic and docosahexaenoic acids acylated in the sn-2 position. These data suggest that differences in the composition of VLDL triacylglycerols may be of major importance in explaining the beneficial effects of dietary olive oil in reducing the atherogenic risk profile in healthy subjects.

[Fever of unknown origin as initial manifestation of Castleman's disease: apropos of 2 cases]. / Fiebre de origen desconocido como primera manifestación de enfermedad de Castleman: a propósito de dos casos.

Castleman's disease is a rare lymphoproliferative disorder with a great range of clinical presentation and localization. It usually appears in young people and its etiology is unknown. Clinical features are not specific: fever, asthenia, hypochromic anemia and hypergammaglobulinemia. We report here two cases of Castleman's disease whose peculiarity lies in the fact that the first sign was fever of unknown origin. In both cases the use of a CT scan was very important for the diagnosis.