Comparative Chemical Characterization of Potato Powders Using 1H NMR Spectroscopy and Chemometrics.

This study presents the metabolic profiling of potato powders obtained through various processing procedures and commercially available potato powders. The metabolic fingerprinting was conducted using 1H NMR-based metabolomics coupled with machine learning projections. The results indicate hot air-dried potatoes have higher fumarate, glucose, malate, asparagine, choline, gamma aminobutyric acid (GABA), alanine, lactate, threonine, and fatty acids. In comparison, steam-cooked potatoes have higher levels of phenylalanine, sucrose, proline, citrate, glutamate, and valine. Moreover, the contents of metabolites in processed potatoes in this study were higher than those found in commercial potato powders, regardless of the drying or cooking methods used. The results indicate that a new processing technique may be developed to improve the nutritional value of potatoes.

Antitumor activity and transcriptome sequencing (RNA-seq) analyses of hepatocellular carcinoma cells in response to exposure triterpene-nucleoside conjugates.

Fifteen betulonic/betulinic acid conjugated with nucleoside derivatives were synthesized to enhance antitumor potency and water solubility. Among these, the methylated betulonic acid-azidothymidine compound (8c) exhibited a broad-spectrum of antitumor activity against three tested tumor cell lines, including SMMC-7721 (IC50 = 5.02 µM), KYSE-150 (IC50 = 5.68 µM), and SW620 (IC50 = 4.61 µM) and along with lower toxicity (TC50 > 100 µM) estimated by zebrafish embryos assay. Compared to betulinic acid (<0.05 µg/mL), compound 8c showed approximately 40-fold higher water solubility (1.98 µg/mL). In SMMC-7721 cells, compound 8c induced autophagy and apoptosis as its concentration increased. Transcriptomic sequencing analysis was used to understand the potential impacts of the underlying mechanism of 8c on SMMC-7721 cells. Transcriptomic studies indicated that compound 8c could activate autophagy by inhibiting the PI3K/AKT pathway in SMMC-7721 cells. Furthermore, in the xenograft mice study, compound 8c significantly slowed down the tumor growth, as potent as paclitaxel treated group. In conclusion, methylated betulonic acid-azidothymidine compound (8c) not only increases water solubility, but also enhances the potency against hepatocellular carcinoma cells by inducing autophagy and apoptosis, and suppressing the PI3K/Akt/mTOR signaling pathway.

Forecasting HIV-1 Genetic Cluster Growth in Illinois,United States.

BACKGROUND: HIV intervention activities directed toward both those most likely to transmit and their HIV-negative partners have the potential to substantially disrupt HIV transmission. Using HIV sequence data to construct molecular transmission clusters can reveal individuals whose viruses are connected. The utility of various cluster prioritization schemes measuring cluster growth have been demonstrated using surveillance data in New York City and across the United States, by the Centers for Disease Control and Prevention (CDC). METHODS: We examined clustering and cluster growth prioritization schemes using Illinois HIV sequence data that include cases from Chicago, a large urban center with high HIV prevalence, to compare their ability to predict future cluster growth. RESULTS: We found that past cluster growth was a far better predictor of future cluster growth than cluster membership alone but found no substantive difference between the schemes used by CDC and the relative cluster growth scheme previously used in New York City (NYC). Focusing on individuals selected simultaneously by both the CDC and the NYC schemes did not provide additional improvements. CONCLUSION: Growth-based prioritization schemes can easily be automated in HIV surveillance tools and can be used by health departments to identify and respond to clusters where HIV transmission may be actively occurring.

Sorting by Race/Ethnicity Across HIV Genetic Transmission Networks in Three Major Metropolitan Areas in the United States.

An important component underlying the disparity in HIV risk between race/ethnic groups is the preferential transmission between individuals in the same group. We sought to quantify transmission between different race/ethnicity groups and measure racial assortativity in HIV transmission networks in major metropolitan areas in the United States. We reconstructed HIV molecular transmission networks from viral sequences collected as part of HIV surveillance in New York City, Los Angeles County, and Cook County, Illinois. We calculated assortativity (the tendency for individuals to link to others with similar characteristics) across the network for three candidate characteristics: transmission risk, age at diagnosis, and race/ethnicity. We then compared assortativity between race/ethnicity groups. Finally, for each race/ethnicity pair, we performed network permutations to test whether the number of links observed differed from that expected if individuals were sorting at random. Transmission networks in all three jurisdictions were more assortative by race/ethnicity than by transmission risk or age at diagnosis. Despite the different race/ethnicity proportions in each metropolitan area and lower proportions of clustering among African Americans than other race/ethnicities, African Americans were the group most likely to have transmission partners of the same race/ethnicity. This high level of assortativity should be considered in the design of HIV intervention and prevention strategies.

Tumor necrosis factor-alfa in nonhealing venous leg ulcers.

BACKGROUND: Venous leg ulcers are responsible for more than half of all lower extremity ulcerations, affecting more than one million Americans annually. Studies have demonstrated alterations in levels of proinflammatory cytokines in patients with chronic wounds, including tumor necrosis factor-alfa (TNFalpha), which may be implicated in wound chronicity. OBJECTIVE: To test the hypothesis that recalcitrant venous leg ulcers have increased local tissue TNFalpha as compared to normal skin. METHODS: Five patients with nonhealing healing chronic venous leg ulcers were recruited. Two 4-mm punch biopsy specimens were obtained: one from the wound margin and one from noninvolved, non-sun exposed normal skin on the flexor aspect of the forearm. Tissue samples were processed using fixed with formalin stained by immunohistochemistry for TNFalpha. Qualitative and quantitative comparisons were made for the presence of TNFalpha receptor in all tissue samples, specifically comparing the presence of TNFalpha in nonhealing venous leg ulcer samples versus normal skin. RESULTS: The overall staining score for nonhealing venous leg ulcers was significantly higher compared to respective normal skin samples (P = .01). In addition, immunostaining for TNFalpha was significantly less in the two nonhealing venous leg ulcers that were present for the shortest duration compared to the other ulcers of longer duration (P = .048). LIMITATIONS: The small sample size may mitigate the clinical implications of findings. CONCLUSIONS: Increased levels of TNFalpha in nonhealing venous leg ulcers, especially those of longer duration, implies that excessive inflammation may be causal in wound chronicity and suggests potential therapeutic alternatives.

Comparison of the effectiveness of the pulsed dye laser 585 nm versus 595 nm in the treatment of new surgical scars.

UNLABELLED: The aim of this study was to compare the effects of the pulsed-dye laser (PDL) at a wavelength of 585 nm with those at 595 nm in the treatment of post-surgical scars, starting on the day of suture removal. The study was a prospective, non-randomized, double-blind, controlled, clinical trial, set in an outpatient clinic. Fifteen outpatients with 21 post-operative scars at least 3 cm long were recruited, and 14 patients with 19 scars completed the study. Scars were divided into three equal portions. Each outer portion was randomly allocated to PDL at 585 nm or at 595 nm (3.5 J/cm(2), 450 micros, 10 mm spot size), and the center was an untreated control; treatment was composed of three laser sessions at 4-week intervals. A blinded examiner evaluated the three scar sections using the Vancouver scar scale for pigmentation, vascularity, pliability, and height. Cosmetic appearance was evaluated with a visual analog scale. Punch biopsies of three randomly selected scars were evaluated. Pigmentation: more scars after laser treatments were of normal color than in the control, but the difference was not statistically significant. Vascularity: after treatment, more scars had normal vascularity in all three groups than at baseline (P < 0.05); the largest increase was with a wavelength of 585 nm (10.5-94.7%), then 595 nm (15.8-78.9%), then control (5.2-36.6%). Pliability: there was more normal pliability in all three groups than at baseline (P < 0.05), with greater improvements in the laser-treated groups. Height: significantly more flat scars after 585 nm PDL (63.2%) than at baseline (21.1%) (P < 0.05). We observed a slight but non-significant decrease in the scar heights with 595 nm PDL in comparison with the control. HISTOLOGY: after laser irradiation, the treated sections were more similar to a non-scarring process than the control. Cosmetic outcome: visual analog scales increased in all groups (P < 0.05), but the greatest increases were observed in the 585 nm and 595 nm laser-treated groups (50% and 60%, respectively) compared with controls (30%). There were significantly higher scores with the lasers than for the control (P < 0.001) at each visit after baseline. Both the 585 nm and 595 nm PDL treatments were effective in improving the appearance and normalizing the vascularity and pliability of post-operative scars. Both wavelengths improved the scars' visual appearance more than controls. We found that 585 nm appears to be the preferred wavelength, as it substantially normalized the height in addition to the vascularity and pliability in a significant number of scars.

The ramp power test: a power assessment during a functional task for older individuals.

BACKGROUND: Power is critical to mobility and activities of daily living and is a key determinant of independence and falls prevention. Therefore, the quantification of power in older persons is critical. The power tests currently available are often expensive, potentially dangerous, and not reflective of everyday activities. We present a modification of an existing field test that uses ambulation up a standard access ramp to quantify functional power in older individuals. METHODS: Three hundred sixty-three women and 157 men, aged 73.1 +/- 7.0 years, ambulated up a standard access ramp (1:12 rise/run ratio) as quickly as possible. Each person performed one practice and two timed trials. RESULTS: Comparisons with accepted power measures and reported patterns of change with aging supported the validity of the ramp power test. The test was found to be reliable across multiple trials and days. Pair-wise comparisons showed that for women the test was sensitive to differences in power output by half-decade, whereas for men it could distinguish between 9 of the 15 comparisons among age groups. Percentile scores are reported by half-decade for power in both genders. In > 1200 trials performed during this study, only one injury (a slightly strained hamstring) occurred. CONCLUSIONS: The ramp power test is valid and reliable and can safely distinguish power by half-decade in women and among the majority of age groups in men. Its safety, low cost, and ease of administration make it a feasible diagnostic tool to assess functional power levels in ambulatory older persons.

Skin cancer awareness and sun protection behaviors in white Hispanic and white non-Hispanic high school students in Miami, Florida.

OBJECTIVE: To examine skin cancer awareness and behavior in white Hispanic (WH) and white non-Hispanic (WNH) high school students because increasing incidence and delayed diagnosis of skin cancer in the growing Hispanic population in the United States represent an emerging health issue. DESIGN: Pilot survey study. SETTING: A high school in Miami, Florida. PARTICIPANTS: A total of 369 high school students (221 WHs and 148 WNHs) were surveyed in the study. MAIN OUTCOME MEASURES: Survey data were collected regarding skin cancer knowledge, perceived risk, and sun protection behaviors. Differences between the 2 groups were compared with chi(2) tests. RESULTS: White Hispanic students were more likely to tan deeply (P = .04) but less likely to have heard of (P < .01) or been told how to perform (P < .01) skin self-examination. White Hispanics were less likely to wear sun-protective clothing or to use sunscreen with a sun protection factor of 15 or higher and reported a greater use of tanning beds. White Hispanic students also thought their chance of developing skin cancer was less than that of WNH students (P < .01), which remained significant after adjustment for age, sex, family history, and skin sensitivity to sun. After adjustment, WHs were 2.5 times more likely than WNHs to have used a tanning bed in the past year. White Hispanics were also 60% less likely to have heard of skin self-examination (P < .01) and 70% less likely than WNHs to have ever been told to perform the examination (P = .03). White Hispanics are about 1.8 and 2 times more likely to never or rarely wear protective clothing (P < .01) and to use sunscreen (P = .01), respectively. CONCLUSION: There are disparities in knowledge, perceived risk of skin cancer, and sun-protective behaviors among WH and WNH high school students.

Predictors of skin cancer screening practice and attitudes in primary care.

BACKGROUND: Physician visits provide invaluable opportunities to screen patients for skin cancer, yielding earlier detection and improved survival. OBJECTIVE: We sought to assess frequency of skin cancer screening by full body skin examinations (FBSE) by primary care physicians, patient attitudes toward FBSE, and risk factors for cutaneous malignancy. METHODS: Questionnaires were distributed to patients at primary care and dermatology clinics. RESULTS: A total of 426 participants were surveyed. Overall, 20% of patients reported having undergone regular FBSE by their primary care physician. Sex, race, personal skin cancer history, and Fitzpatrick skin type were predictive of whether a FBSE was performed by a patient's primary care physician. Men were more likely to report having undergone a FBSE (22% vs 19%; P < .01); women were more likely to report feeling embarrassed by a FBSE (15% vs 4%; P < .01). LIMITATIONS: This study was conducted at a single site academic center. CONCLUSION: Although low rates of skin cancer screening are reported by patients, those at higher risk are being screened more frequently. Sex disparity exists, and as both male and female patients have a strong preference to undergo FBSE, unmet opportunities for skin cancer prevention should be maximized.

Care coordination and telemedicine improves glycaemic control in ethnically diverse veterans with diabetes.

We conducted a pilot study of a care-coordination programme involving daily monitoring and education of elderly diabetic veterans from different racial/ethnic groups. A telephone-based, in-home messaging device was used for patient monitoring and education. Sixty-nine patients were enrolled in the study and HbA(1c) values were obtained both before and after the telemedicine intervention in 41 of them. The mean HbA(1c) before enrolment was 7.6% and the mean value 9 months later was 7.3% (P = 0.09). The greatest fall in HbA(1c) occurred in African-Americans (0.65%, P = 0.05). The total number of hospital admissions decreased from 31 pre-enrolment to 25 post-enrolment (P = 0.0002). Bed days of care decreased from 368 to 149 (P = 0.0002). Care coordination, facilitated by telemedicine, appeared to improve glycaemic control in veterans with diabetes from diverse ethnic backgrounds, particularly African-Americans. This may reduce health-care resource utilization.

A robust anonymous biometric-based authenticated key agreement scheme for multi-server environments.

In order to improve the security in remote authentication systems, numerous biometric-based authentication schemes using smart cards have been proposed. Recently, Moon et al. presented an authentication scheme to remedy the flaws of Lu et al.'s scheme, and claimed that their improved protocol supports the required security properties. Unfortunately, we found that Moon et al.'s scheme still has weaknesses. In this paper, we show that Moon et al.'s scheme is vulnerable to insider attack, server spoofing attack, user impersonation attack and guessing attack. Furthermore, we propose a robust anonymous multi-server authentication scheme using public key encryption to remove the aforementioned problems. From the subsequent formal and informal security analysis, we demonstrate that our proposed scheme provides strong mutual authentication and satisfies the desirable security requirements. The functional and performance analysis shows that the improved scheme has the best secure functionality and is computational efficient.

The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer.

BACKGROUND: Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO). METHODS: We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001. RESULTS: Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer. CONCLUSIONS: Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.

Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease.

BACKGROUND: Patients with peripheral arterial disease (PAD) have increased mortality compared with patients without PAD. Coronary artery disease (CAD) accounts for almost 75% of deaths in PAD patients. Studies suggest that PAD is underdiagnosed and atherosclerotic risk factors undertreated when compared with CAD. OBJECTIVE: To determine whether cholesterol guidelines are being met in patients with PAD and to determine whether any independent factors increase the likelihood of reaching goal low-density lipoprotein (LDL). DESIGN: A retrospective chart review of subjects diagnosed with PAD in 2001 at 2 Veterans Affairs Medical Centers. MEASUREMENTS: Univariate analysis compares baseline characteristics between those reaching goal and those who do not. Multivariate logistic regression analysis identified predictors of meeting LDL goal among PAD patients. RESULTS: Of 315 patients, 62% reached goal LDL. Those more likely to reach goal were older, had hypertension, and a history of CAD and stroke. Positive predictors of LDL goal were age and CAD, while smoking was a negative predictor. CONCLUSION: The majority of veterans with PAD received lipid-lowering medication and achieve goal LDL, but they are more likely to do so if they are older than 70 and have a history of CAD.

Full-body skin examinations and the female veteran: prevalence and perspective.

OBJECTIVES: To determine the frequency of full-body skin examinations (FBSEs) among female veterans and to determine whether patient risk factors for skin cancer alter the frequency of screening. Subjects were also queried as to attitudes about FBSE. DESIGN: Questionnaires pertaining to whether patients underwent regular FBSE, their opinions and attitudes about this screening test, and their risks for developing skin cancer. SETTING: A primary health care clinic for female veterans at a Veterans Affairs medical center. PARTICIPANTS: A convenience sample of 245 patients awaiting clinic appointments. Of those asked to participate, 201 agreed, for a participation rate of 82%. MAIN OUTCOME MEASURES: Patient report of undergoing FBSE, attitudes regarding FBSE, and risk factors for cutaneous malignancy. RESULTS: Eighteen percent of all respondents reported undergoing regular FBSE by their primary care provider, whereas 9 (45%) of the 20 with a history of skin cancer reported undergoing FBSE. Fifteen percent of subjects reported embarrassment with FBSE. Seventy-nine percent reported that their primary care provider would be considered thorough by performing FBSE, and 69% would like their primary care provider to perform FBSE regularly. We found that 16% of subjects would refuse the examination if the primary care provider were of the opposite sex, whereas 38% would not refuse but be less willing to be examined. CONCLUSIONS: Female veterans report a low incidence of FBSE, although those with a personal history of skin cancer are more likely to undergo screening. Despite embarrassment expressed about a sex difference between the patient and examiner, female veterans have a strong preference to undergo FBSE.

Cancer incidence in Florida professional firefighters, 1981 to 1999.

OBJECTIVE: The objective of this study was to examine the cancer risk associated with firefighting. METHODS: Standardized incidence ratio analysis (SIR) was used to determine the relative cancer risk for firefighters as compared with the Florida general population. RESULTS: Among 34,796 male (413,022 person-years) and 2,017 female (18,843 person-years) firefighters, 970 male and 52 female cases of cancer were identified. Male firefighters had significantly increased incidence rates of bladder (SIR = 1.29; 95% confidence interval = 1.01-1.62), testicular (1.60; 1.20-2.09), and thyroid cancers (1.77; 1.08-2.73). Female firefighters had significantly increased incidence rates of overall cancer (1.63; 1.22-2.14), cervical (5.24; 2.93-8.65), and thyroid cancer (3.97; 1.45-8.65) and Hodgkin disease (6.25; 1.26-18.26). CONCLUSIONS: Firefighting may be associated with an increased risk of selected site-specific cancers in males and females, including an overall increased cancer risk in female firefighters.

Vitamin d deficiency and seasonal variation in an adult South Florida population.

Hypovitaminosis D is associated with impaired neuromuscular function, bone loss, and fractures. If a person is not taking a vitamin supplement, sun exposure is often the greatest source of vitamin D. Thus, vitamin D deficiency is not uncommon in the winter, particularly in northern latitudes. Our goal was to establish the prevalence of vitamin D deficiency in south Florida (U.S.), a region of year-round sunny weather. At the end of the winter, 212 men and women attending an internal medicine clinic at a local county hospital were enrolled for measurements of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D, and PTH; 99 participants returned at the end of summer. The mean (+/-sd) winter 25(OH)D concentration was 24.9 +/- 8.7 ng/ml (62.3 +/- 21.8 nmol/liter) in men and 22.4 +/- 8.2 ng/ml (56.0 +/- 20.5 nmol/liter) in women. In winter, the prevalence of hypovitaminosis D, defined as 25(OH)D less than 20 ng/ml (50 nmol/liter), was 38% and 40% in men and women, respectively. In the 99 subjects who returned for the end of summer visit, the mean 25(OH)D concentration was 31.0 +/- 11.0 ng/ml (77.5 +/- 27.5 nmol/liter) in men and 25.0 +/- 9.4 ng/ml (62.5 +/- 23.5 nmol/liter) in women. Seasonal variation represented a 14% summer increase in 25(OH)D concentrations in men and a 13% increase in women, both of which were statistically significant. The prevalence of hypovitaminosis D is considerable even in southern latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis.

The effect of Medicare health care systems on women with breast and cervical cancer.

OBJECTIVE: Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001. METHODS: We used a linkage of 2 national databases: the Medicare database from the Centers for Medicare and Medicaid Services and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database to evaluate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer. RESULTS: We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients. CONCLUSION: Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

The association of Medicare health care delivery systems with stage at diagnosis and survival for patients with melanoma.

OBJECTIVE: To evaluate differences in the stage at diagnosis and survival for melanoma between the 2 most common types of Medicare health care delivery systems, fee-for-service (FFS) and managed care (health maintenance organizations [HMOs]), in the United States during the period from January 1, 1985, through December 31, 1994. DESIGN: We used a linkage of 2 national databases, ie, the Medicare database from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the National Cancer Institute Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival for melanoma between the HMO and FFS groups. Patients A population of 4608 patients (62% men; 92% white). RESULTS: We found an earlier stage of diagnosis for the HMO group compared with the FFS group for melanoma as the first cancer diagnosis, but this did not persist when melanoma was the second or a later cancer diagnosis. For patients with melanoma as the first cancer diagnosis, improved survival was related to earlier stage at diagnosis. CONCLUSIONS: Differences exist in stage at diagnosis between patients in HMOs compared with those in FFS health care plans. This is likely due in part to utilization of services or access to care for patients in HMOs, and may be similar to that of patients in FFS plans with a previous cancer diagnosis before their diagnosis of melanoma. We did not find an increased risk of diagnosis with a late-stage cancer among patients with vs those without a previous cancer diagnosis. Improved survival appears to be related to earlier stage at diagnosis.

Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis.

BACKGROUND: Methotrexate (MTX) is a folate analogue used in the treatment of moderate to severe psoriasis and rheumatoid arthritis (RA). It oppositely affects inflammation and hyperhomocysteinemia-two independent risk factors for vascular disease. To date, there are no published reports evaluating the impact of these potentially paradoxical action of MTX. OBJECTIVE: The purpose of this study was to evaluate the effect of MTX therapy on the incidence of vascular disease in patients with psoriasis and RA. METHODS: We conducted a retrospective cohort study in which we analyzed computerized records of 7,615 outpatients diagnosed with psoriasis and 6,707 with RA at the Veterans Integrated Service Network 8. RESULTS: Patients prescribed MTX therapy had a significantly reduced risk of vascular disease compared to those who were not prescribed MTX (psoriasis: RR = 0.73, 95% CI = 0.55-0.98; RA: 0.83, 0.71-0.96). This reduction was most evident for patients prescribed a low cumulative dose of MTX (psoriasis: RR = 0.50, 95% CI = 0.31-0.79; RA = 0.65, 0.52-0.80). Concomitant use of folic acid (FA) with MTX also reduced the incidence of vascular disease in patients prescribed MTX (psoriasis: RR = 0.56, 95% CI = 0.39-0.80; RA: 0.77, 0.38-1.56). CONCLUSIONS: MTX therapy reduced the incidence of vascular disease in veterans with psoriasis or RA. Low to moderate cumulative dose appears more beneficial than the higher dose. We hypothesize that this effect is caused by its anti-inflammatory properties. In addition, a combination of MTX and FA led to a further reduction in the incidence of vascular disease.