Demographic and clinical profile of patients treated with proximal femoral nails - a 10-year analysis of more than 40,000 Cases.

BACKGROUND: Hip fractures are common in elderly populations and can be life threatening. Changes in healthcare delivery and outcomes for patients with hip fracture treated with intramedullary nails are not well characterized. The objectives of our study were: 1) the characterization of patients treated with the Trochanteric Fixation Nail -Advanced™(TFNA) Proximal Femoral Nailing System or comparable nails (index) and estimate 12-month all-cause readmissions (ACR) and reoperations following index; and 2) the evaluation of 10-year healthcare utilization (HCU) trends for treatment of femoral fractures with femoral nails. METHODS: This is a retrospective database analysis using the Premier hospital database. All adults with femoral fracture treated with an intramedullary nail, from 2010 to Q3 2019, in the inpatient setting, were identified. Exclusion criteria included patients with bilateral hip surgery and presence of breakage at time of initial surgery. The primary outcome was ACR and reoperation, the secondary outcomes were healthcare utilization metrics. Variables included demographics, comorbidities (Elixhauser Index (EI)), surgical intervention variables and hospital characteristics. RESULTS: Forty-one thousand one hundred four patients were included in the study, of which 14,069 TFNA patients, with average age 77.9 (Standard deviation (SD): 12.0), more than 60% with 3 or more comorbidities (more than 64% for TFNA), 40% with severe or extreme disease severity and one third with severe or extreme risk for mortality. ACR reached 60.1% (95% confidence interval (CI): 59.6%-60.5%) - for TFNA: 60.0% (95%CI: 59.2%-60.8%). The reoperation rate was 4.0% (95%CI: 3.8%-4.2%) - for TFNA: 3.8% (95%CI: 3.5%-4.1%). Length of stay (LOS) averaged 5.8 days (SD: 4.8), and 12-month hip reoperation was 4.0% (3.8%-4.2%), in TFNA cohort: 3.8% (3.5%-4.1%). From 2010 to 2019: the percentage patients operated within 48 h of admission significantly increased, from 75.2% (95%CI: 74.3%-76.1%) to 84.3% (95%CI: 83.9%-84.6%); LOS significantly decreased, from 6.2 (95%CI: 6.0-6.4) to 5.6 (95%CI: 5.5-5.7) days; discharge to skilled nursing facilities (SNF) increased from 56.0% (95%CI: 54.8%-57.2%) to 61.5% (95%CI: 60.8%-62.2%); ACR rates decreased but reoperation rates remained constant. CONCLUSIONS: ACR and reoperation rates were similar across device types and averaged 60.1% and 4.0%, respectively. Ten-year analyses showed reductions in hospital HCU and greater reliance on SNF.

Questionnaire-based Analysis of Owner-reported Scratching and Pain Signs in Cavalier King Charles Spaniels Screened for Chiari-like Malformation and Syringomyelia.

BACKGROUND: Chiari-like malformation (CM) and syringomyelia (SM) cause a pain syndrome in Cavalier King Charles spaniels (CKCS). Clinical signs are not consistently apparent on neurologic examination, and owner reporting of signs provides vital clinical history. However, owner questionnaires for this disease are not well developed. OBJECTIVES: To develop a tool to capture owner-reported clinical signs for use in clinical trials and to compare owner-reported signs with the presence of pain on neurologic examination and SM on magnetic resonance imaging (MRI). ANIMALS: Fifty client-owned CKCS. METHODS: Owners completed a questionnaire and pain/scratch map. Each dog underwent a neurologic examination and craniocervical magnetic resonance imaging (MRI). Questionnaire responses were developed into scores, area of shading for pain/scratch maps was measured, and consistency of responses between these tools was assessed. Owner-reported findings were compared with neurologic examination findings and presence and severity of SM on MRI. RESULTS: Thirty-three dogs were symptomatic and 17 asymptomatic; 30 had SM. The most common sign of pain was crying out when lifted (n = 11). Extent of shaded areas on maps positively correlated with questionnaire scores for pain (r2  = 0.213, P = 0.006) and scratch (r2  = 0.104, P = 0.089). Owner-reported findings were not significantly associated with presence or severity of SM or neurologic examination findings. Owner-reported lateralization of signs was significantly associated with SM lateralization (P < 0.0001). CONCLUSIONS: The questionnaire and maps may be useful for clinical trials. Lack of association of owner-reported signs with SM highlights our lack of understanding of the pathophysiology of pain in this disease.

Porcine Reproductive and Respiratory Syndrome virus reduces feed efficiency, digestibility, and lean tissue accretion in grow-finish pigs.

Porcine reproductive and respiratory syndrome (PRRS) virus is a major swine virus that causes reproductive impairment in sows, as well as respiratory disease, reduction in growth rates, and mortalities in all ages of pigs. The objective of this study was to quantify the impact PRRS has on grower-finisher pig feed efficiency and tissue accretion rates. Thirty PRRS naïve, littermate pairs of maternal line Choice Genetics gilts (33.6 ± 0.58 kg BW) were selected and pairs split across 2 barns consisting of 5 pens (n = 6 pigs/pen per barn). Pigs in both barns were fed corn-soybean-DDGS diets ad libitum. All pigs in one barn were inoculated (CHAL) via an i.m. injection of a live PRRS strain isolated from the region (0 d post inoculation, dpi), while pigs in the other barn were given a saline control injection (CONT). Pig performance (ADG, ADFI, G:F) was assessed from 35 kg BW until each group reached market BW (128 kg). Additionally, longitudinal apparent total tract digestibility (ATTD) and body composition was assessed using Dual-energy X-ray absorptiometry (DXA) post inoculation (dpi) to estimate lean, protein, fat and bone accretion rates. Serological data from CHAL pigs showed that PRRS titers peaked 7 dpi and these pigs seroconverted by 35 dpi. According to both genomic and protein PRRS titers, CONT pigs were naïve to CHAL throughout the study. The PRRS infection reduced (P < 0.001) ATTD of dry matter, energy and nitrogen by 3 to 5% at 21 dpi and the reduction in ATTD persisted after 65 dpi. Compared to the CONT, CHAL pigs had decreased ADG (0.89 vs. 0.80 kg/d, P < 0.001), ADFI (2.05 vs. 1.93 kg/d, P < 0.001), and G:F (0.44 vs. 0.41 kg/d, P < 0.001) over the entire test period. The CHAL pigs also had attenuated DXA predicted whole body accretion of lean (547 vs. 633 g/d, P = 0.001), protein (109 vs. 126 g/d, P = 0.001) and fat (169 vs. 205 g/d, P = 0.001) compared to their CONT counterparts from dpi 0 to 80. Based on carcass data at slaughter (and consistent with the DXA data), CHAL pigs had leaner carcasses and reduced yields. These data clearly demonstrate that PRRS infection reduces digestibility, feed efficiency and protein accretion rates in grower-finisher pigs.

Effect of ferrous ion concentration on the kinetics of radiation-induced iron-oxide nanoparticle formation and growth.

Magnetite nanoparticles were formed by γ-radiolysis of solutions containing different initial concentrations of FeSO4 without any other chemical additives. The particles formed in a given [Fe2+]0 had a narrow size distribution and the average size increased with [Fe2+]0. Five hour irradiation at 0.8 Gy s-1 produced an average size ranging from 23 ± 2 nm to 300 ± 40 nm in 0.1 mM or 10 mM [Fe2+]0 solutions, respectively. To ascertain the size-determining mechanism, the kinetics of γ-radiation-induced particle formation and growth were investigated by simultaneously analyzing the [H2(g)] in the headspace, the [FeII] and [FeIII] dispersed in solution, UV-Vis absorbances at 304 nm and 380 nm, and the pH of the solution. The particles formed were characterized by TEM imaging and various spectroscopic analyses. For a given [Fe2+]0 the time-dependent behaviours of different analyses collectively show three distinct kinetic stages of iron oxidation. The [Fe2+]0 affects the oxidation kinetics of different stages and hence, the oxidation yields and the size of particles formed after irradiation. The main processes which cause the observed kinetics and yields in the three stages are proposed.

Concentration gradient patterns of traffic and non-traffic-generated fine and coarse aerosol particles.

The research project described in this article was undertaken to establish baseline information for a Health Impact Assessment (HIA) project of Interstate 75 road construction in Cincinnati, Ohio. The objective of the authors' study was to evaluate the concentrations of elemental and organic carbon (EC and OC), as well as characterize particle number concentrations using devices that measure the fine fraction in the range of 0.02-1 microm and the coarse fraction up to 20 pm. The measurements were conducted at two sites located in the proximity of an interstate highway (at 124 and 277 m) as well as at a remote control site (at >2000 m from any interstate highway). Samples were collected for 24 hours over 12 days in each season (i.e., summer, fall, and winter). Wind data were obtained from the area weather station. Data were analyzed using mixed linear models. Significant increases in concentrations of EC, OC, and fine particles as well as in EC/OC ratios were observed with decreased distance to the highway; this difference was more pronounced in the fall. These results suggest that residents and workers in areas near high-traffic highways may be exposed to elevated levels of airborne fine particles. The results can be used as a baseline for future HIAs of road construction in the area.

Targeting mTOR: prospects for mTOR complex 2 inhibitors in cancer therapy.

Small molecule inhibitors that selectively target cancer cells and not normal cells would be valuable anti-cancer therapeutics. The mammalian target of rapamycin complex 2 (mTORC2) is emerging as a promising candidate target for such an inhibitor. Recent studies in cancer biology indicate that mTORC2 activity is essential for the transformation and vitality of a number of cancer cell types, but in many normal cells, mTORC2 activity is less essential. These studies are intensifying interest in developing inhibitors that specifically target mTORC2. However, there are many open questions regarding the function and regulation of mTORC2 and its function in both normal and cancer cells. Here, we summarize exciting new research into the biology of mTORC2 signaling and highlight the current state and future prospects for mTOR-targeted therapy.

Detailed analysis of the expression of an alpha-gliadin promoter and the deposition of alpha-gliadin protein during wheat grain development.

BACKGROUND AND AIMS: Alpha-gliadin proteins are important for the industrial quality of bread wheat flour, but they also contain many epitopes that can trigger celiac (coeliac) disease (CD). The B-genome-encoded alpha-gliadin genes, however, contain very few epitopes. Controlling alpha-gliadin gene expression in wheat requires knowledge on the processes of expression and deposition of alpha-gliadin protein during wheat grain development. METHODS: A 592-bp fragment of the promotor of a B-genome-encoded alpha-gliadin gene driving the expression of a GUS reporter gene was transformed into wheat. A large number of transgenic lines were used for data collection. GUS staining was used to determine GUS expression during wheat kernel development, and immunogold labelling and tissue printing followed by staining with an alpha-gliadin-specific antibody was used to detect alpha-gliadin protein deposited in developing wheat kernels. The promoter sequence was screened for regulatory motifs and compared to other available alpha-gliadin promoter sequences. KEY RESULTS: GUS expression was detected primarily in the cells of the starchy endosperm, notably in the subaleurone layer but also in the aleurone layer. The alpha-gliadin promoter was active from 11 days after anthesis (DAA) until maturity, with an expression similar to that of a 326-bp low molecular weight (LMW) subunit gene promoter reported previously. An alpha-gliadin-specific antibody detected alpha-gliadin protein in protein bodies in the starchy endosperm and in the subaleurone layer but, in contrast to the promoter activity, no alpha-gliadin was detected in the aleurone cell layer. Sequence comparison showed differences in regulatory elements between the promoters of alpha-gliadin genes originating from different genomes (A and B) of bread wheat both in the region used here and upstream. CONCLUSIONS: The results suggest that additional regulator elements upstream of the promoter region used may specifically repress expression in the aleurone cell layer. Observed differences in expression regulator motifs between the alpha-gliadin genes on the different genomes (A and B) of bread wheat leads to a better understanding how alpha-gliadin expression can be controlled.

The accuracy of reporting of general anaesthesia for childbirth: a validation study.

Administrative population health data, such as hospital discharge data, are a potentially valuable resource for determining anaesthesia and analgesia use in childbirth at a population level. However the reliability of general anaesthesia reporting is unknown. This study aimed to determine the accuracy of the reporting of peripartum general anaesthesia in single and linked population health data. Data from a statewide validation study of 1200 women provided the gold standard for delivery and postpartum general anaesthesia use. The validation data were merged with both the hospital discharge and birth databases. As both of these datasets collect information on general anaesthesia, it could be reported in one, both or neither database. Among the 1184 records available for review, 7.7% of women had a general anaesthetic during the birth admission, of which 6.2% were for delivery and 1.5% were for a postpartum procedure. Reporting sensitivities ranged from 26% to 97% and specificities 94% to 100%. Identifying general anaesthesia from either the birth or hospital data improved general anaesthesia ascertainment. Limiting analysis to caesarean sections resulted in very accurate identification of general anaesthesia for delivery (sensitivity 97.0%, specificity 99.8%) while limiting to vaginal births was moderately accurate for identifying postpartum general anaesthesia (sensitivity 73.2%, specificity 99.8%). General anaesthesia for delivery is reported with a high level of accuracy in birth and linked birth-hospital data, but not in hospital discharge data alone. Population health data are a reliable source for examining general anaesthesia for delivery.

Factors influencing successful Agrobacterium-mediated genetic transformation of wheat.

The development of a robust Agrobacterium-mediated transformation protocol for a recalcitrant species like bread wheat requires the identification and optimisation of the factors affecting T-DNA delivery and plant regeneration. We have used immature embryos from range of wheat varieties and the Agrobacterium strain AGL1 harbouring the pGreen-based plasmid pAL156, which contains a T-DNA incorporating the bar gene and a modified uidA (beta-glucuronidase) gene, to investigate and optimise major T-DNA delivery and tissue culture variables. Factors that produced significant differences in T-DNA delivery and regeneration included embryo size, duration of pre-culture, inoculation and co-cultivation, and the presence of acetosyringone and Silwet-L77 in the media. We fully describe a protocol that allowed efficient T-DNA delivery and gave rise to 44 morphologically normal, and fully fertile, stable transgenic plants in two wheat varieties. The transformation frequency ranged from 0.3% to 3.3%. Marker-gene expression and molecular analysis demonstrated that transgenes were integrated into the wheat genome and subsequently transmitted into progeny at Mendelian ratios.

Increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients. THROMBO Investigators.

Diabetes is an established risk factor for reinfarction and cardiac death in postinfarction patients. Since the underlying mechanism of diabetes-related risk is not fully understood we aimed to evaluate the association between lipids, thrombogenic factors and diabetes in postinfarction patients. The study population consisted of 1,045 postinfarction patients (846 non-diabetic, 125 non-insulin- and 74 insulin-requiring diabetics) with the following blood tests performed 2 months after an index myocardial infarction: lipoprotein (a), apolipoprotein-B, apolipoprotein-A, cholesterol, HDL cholesterol, triglycerides, insulin, von Willebrand factor (vWF), fibrinogen, factor VII, D-dimer, and plasminogen activator inhibitor (PAI-1). After adjustment for relevant clinical covariates, non-insulin-requiring diabetes was significantly (p < 0.05) associated with elevated levels of (odd ratios per 1 log unit increase in parenthesis) vWF (1.74) and PAI-1 (1.42) whereas insulin requiring diabetes was associated with even more elevated levels of vWF (4.68), but not with increased levels of PAI-1. No significant differences in lipid levels were observed among three groups. In conclusion, increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients, suggesting that endothelial damage is the primary mechanisms contributing to an increased occurrence of vascular and cardiac events in diabetic postinfarction patients.

Factors influencing Agrobacterium-mediated transient expression of uidA in wheat inflorescence tissue.

A critical step in the development of Agrobacterium tumifaciens-mediated transformation is the establishment of optimal conditions for T-DNA delivery into tissue from which whole plants can be regenerated. The efficient transformation of inflorescence tissue from 'Baldus', a commercial wheat variety, using the Agrobacterium strain AGLI harbouring the binary vector pAL156 is reported here. The effects of various factors on delivery and the transient expression of the uidA gene were studied including the duration of preculture, vacuum infiltration, the effect of sonication treatments, and Agrobacterium cell density. Optimal T-DNA delivery (as measured by uidA activity) was obtained from inflorescence tissues precultured for 21 d and sonicated. Increasing Agrobacterium cell density, the duration of inoculation/co-cultivation, and vacuum pressure, up to a threshold, increased uidA expression. The investigation of factors that influence T-DNA delivery is an important first step in the utilization of Agrobacterium in the transformation of immature wheat inflorescence tissue.

Age-dependent transformation frequency in elite wheat varieties.

Wheat is a major world crop and as such is a primary target for improvement of agronomic characteristics via genetic engineering. Optimization of transformation is essential in order to overcome the relatively low transformation frequencies encountered with wheat. Transformation of elite wheat varieties is not always successful due to variability in regeneration and transformation frequencies between varieties. In this work, two elite wheat varieties with a relatively high embryogenic capacity were transformed by particle bombardment. A strong correlation between transformation frequency and the age of wheat donor plants was observed in both varieties. The mean transformation frequency rose from 0.7% to 5% when using immature embryos from old and young donor plants, respectively. This was observed in both varieties, the best bombardments achieving up to 7.3% frequency. Using explants at an optimal developmental stage from donor plants grown under environmentally-controlled conditions has improved the reproducibility of transformation efficiency of elite wheat varieties and leads to the production of apparently phenotypically normal, fertile, transgenic plants.

Revised guidelines for Urist's Mutuality of Autonomy Scale (MOA).

Research findings reported in the literature with less than 80% interrater agreement for the Rorschach Mutuality of Autonomy (MOA) scale may be problematic due to possible error. In preparation for a new Rorschach study using the MOA scale, we found it necessary to revise and clarify MOA scale scoring guidelines because they were confusing and ambiguous. A group of 19 naive graduate students improved their interrater agreement scores from 67% using guidelines from the literature, to 75% on the first revision, and these 19 raters plus 13 new raters produced an 80% agreement on a second revision. This revision, with only minor changes based on raters' feedback, is included in an appendix.

Unusual aortic arch variation: distal origin of common carotid arteries.

As part of a larger study, the aortic arch and its branches were removed en bloc at autopsy from men of Japanese ancestry born in Hawaii. Of the 193 arterial trees examined, 182 (94.3%) had a typical branching pattern (e.g., brachiocephalic trunk, left common carotid, and left subclavian arteries, in that order). Two specimens had only two branches arising from the aortic arch, a common trunk uniting the brachiocephalic and left common carotid arteries and a left subclavian artery. Nine individuals (4.6%) had four branches off the aortic arch; in eight of these cases (4.1%), the left vertebral artery originated directly off the aortic arch just proximal to, or as a common trunk with, the left subclavian artery. A unique aortic arch branching pattern was found in one of these men. The four arteries arising from the arch of the aorta were, in sequence: right subclavian, left subclavian, right common carotid, and left common carotid. The literature on aortic arch variations is reviewed and the possible embryonic development of these branching patterns and their clinical significance is discussed briefly.

Local and national uses of a Road to Recovery evaluation.

Evaluation fellows from the George Washington University School of Public Health and Health Services conducted an evaluation of the Road to Recovery program of the Mid-Atlantic division of the American Cancer Society. The evaluation included qualitative analysis of program operation, mailed surveys, in-depth interviews with patients and drivers, and interviews with social workers from treatment centers. Results indicated that patients and drivers were satisfied with the program. Patients appreciated the ability of drivers to provide personalized, reliable service. The recruitment of sufficient drivers to meet transportation demand was a problem. High staff turnover and a lack of electronic tracking of standard information hindered program monitoring. A Mid-Atlantic Advisory Transportation Group reviewed the findings and made recommendations for service improvement. The Mid-Atlantic division evaluation contributed to an "evaluation synthesis" in which participants from the three divisions that had conducted Road to Recovery evaluations examined study data and made recommendations for reorganizing the national transportation program. A Transportation Program Design Team then held fact-finding meetings and adopted goals and objectives for a new national transportation program. The primary lesson learned was the far-reaching effects that a single program evaluation may have for various stakeholders and for an organization.

Insulin-treated Zucker diabetic fatty rats retain the hypertriglyceridemia associated with obesity.

Lipoprotein and apolipoprotein changes were evaluated in 10-week-old Zucker diabetic fatty (ZDF) male rats following 12 weeks of insulin treatment, which normalized blood glucose and maintained weight gaining characteristic of nondiabetic Zucker fatty rats. Compared with untreated ZDF rats (saline-injected), insulin treatment resulted in increased very-low-density lipoprotein (VLDL; d < 1.006 g/mL) and decreased alpha lipoprotein on agarose gel electrophoresis. These findings were consistent with an observed increase in VLDL triglyceride and cholesterol, and decreased high-density lipoprotein (HDL) cholesterol with insulin treatment in isolated lipoproteins. B100 levels were unchanged by insulin treatment, but B48 levels were significantly increased in the VLDL fraction. Insulin treatment depressed apolipoprotein (apo) A-I levels in HDL, but had little effect on total apo E, apo A-IV, or apo C, although apo C was redistributed to the VLDL fraction. These results suggest that insulin treatment of ZDF rats normalizes hyperglycemia and prevents age-related changes in lipoprotein parameters associated with development of insulinopenic diabetes. Insulin therapy in ZDF rats thereby sustains the hyperlipidemic lipoprotein pattern associated with hyperinsulinemia and obesity.

Effect of smoking on lipid and thrombogenic factors two months after acute myocardial infarction.

Cigarette smoking is linked to increased cardiac morbidity and mortality, and has been shown to affect both lipid profiles and thrombotic factors in healthy subjects. However, the influence of smoking on the atherothrombotic environment has not been studied in a large population of patients after acute myocardial infarction (AMI). Blood samples and medical history, including smoking status, were obtained from 1,045 patients at a 2-month visit after AMI. Smokers were asked to refrain 24 hours before the visit, but not all complied. Measurements included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein-B, apolipoprotein-A, triglycerides, factor VII, factor VIIa, von Willebrand factor, D-dimer, and plasminogen activator inhibitor. There were 247 current, 443 past, and 349 nonsmokers. After adjustment for clinical variables, current smokers had higher levels of total cholesterol and apolipoprotein-B than past and nonsmokers (p <0.01). High-density lipoprotein cholesterol and apolipoprotein-A levels were similar between groups. Fibrinogen was elevated in current (p = 0.001) and past (p = 0.029) smokers, compared with nonsmokers. Smokers who smoked within 24 hours of blood sampling had higher apolipoprotein-B (p = 0.005), total cholesterol (p = 0.001), and fibrinogen (p = 0.015) levels than those who refrained from smoking. In conclusion, postinfarction patients, who historically have higher levels of atherogenic lipids than healthy subjects, have increased levels of these lipids attributed to active smoking. After smoking cessation, lipid profiles approach nonsmoker levels, but fibrinogen remains elevated. Smoking within 24 hours of blood sampling was associated with further adverse prothrombotic and lipogenic effects.

Glucose-stimulated insulin secretion suppresses hepatic triglyceride-rich lipoprotein and apoB production.

The current study assessed in vivo the effect of insulin on triglyceride-rich lipoprotein (TRL) production by rat liver. Hepatic triglyceride and apolipoprotein B (apoB) production were measured in anesthetized, fasted rats injected intravenously with Triton WR-1339 (400 mg/kg). After intravascular catabolism was blocked by detergent treatment, glucose (500 mg/kg) was injected to elicit insulin secretion, and serum triglyceride and apoB accumulation were monitored over the next 3 h. In glucose-injected rats, triglyceride secretion averaged 22.5 +/- 2.1 microg.ml(-1).min(-1), which was significantly less by 30% than that observed in saline-injected rats, which averaged 32.1 +/- 1.4 microg.ml(-1).min(-1). ApoB secretion was also significantly reduced by 66% in glucose-injected rats. ApoB immunoblotting indicated that both B100 and B48 production were significantly reduced after glucose injection. Results support the conclusion that insulin acts in vivo to suppress hepatic very low density lipoprotein (VLDL) triglyceride and apoB secretion and strengthen the concept of a regulatory role for insulin in VLDL metabolism postprandially.

B48 is preferentially translated over B100 in cells with increased endogenous apo B mRNA.

We recently demonstrated that expression of BHMT in McArdle RH-7777 (McA-BHMT) cells increases apo B mRNA abundance, leading to parallel increases in apo B secretion. The ratio of unedited to edited apo B mRNA was unchanged by BHMT expression. Based on the observation that secretion of B48 is increased relative to B100 in McA-BHMT cells, current studies now include comparison of B48 and B100 synthesis and intracellular degradation. Minor differences in co- and posttranslational degradation were unable to account for relative increase in B48 secretion, and the disappearance kinetics of B48 were similar in McA-BHMT and control cells. Consistent with the increase in endogenous apo B mRNA in McA-BHMT cells, B48 synthesis is increased significantly. In contrast, synthesis of B100 was not significantly increased. We conclude that B48 is preferentially translated compared to B100 when endogenous apo B mRNA is increased.

Gender-related differences in thrombogenic factors predicting recurrent cardiac events in patients after acute myocardial infarction. The THROMBO Investigators.

Thrombosis contributes to recurrent coronary events in patients after acute myocardial infarction (AMI), but prognostic significance of thrombogenic factors by gender is unknown. This study aimed to determine gender-related differences in the prognostic significance of thrombogenic factors for predicting cardiac events (nonfatal reinfarction or cardiac death) in postinfarction patients. Blood levels of the following factors were measured 2 months after AMI in 791 men and 254 women: fibrinogen, von Willebrand factor, factor VII and VIIa, plasminogen activator inhibitor, D-dimer, cholesterol, apolipoprotein A-1, apolipoprotein B, lipoprotein(a), triglycerides, and high-density lipoprotein cholesterol. After adjustment for clinical covariates, levels of apolipoprotein A, high-density lipoprotein cholesterol, fibrinogen, and factor VIIa were significantly higher in postinfarction women than men. During a mean 26-month follow-up, there were 67 cardiac events (8.5%) in men and 14 (5.5%) in women (p = 0.11). In the multivariate Cox model, elevated levels of factor VIIa were a significant predictor of cardiac events in women (p = 0.022) but not in men (p = 0.80), with significant gender-related effect (hazard ratio 2.80 vs 0.92, respectively; p <0.05). D-dimer had prognostic value in men (p = 0. 006) but not in women (p = 0.36), although the difference between hazard ratios for men and women was not significant (2.35 vs 1.58, respectively; p = 0.49). In conclusion, elevated levels of factor VIIa are associated with an increased risk of recurrent cardiac events in postinfarction women, but not in men. D-dimer is more predictive for cardiac events in postinfarction men than women. These observations indicate possible gender-related differences in the pathophysiologic mechanisms of recurrent cardiac events.