Plant-derived polyphenols regulate expression of miRNA paralogs miR-103/107 and miR-122 and prevent diet-induced fatty liver disease in hyperlipidemic mice.

BACKGROUND: MicroRNAs have the potential for clinical application. Probable modulation by plant-derived polyphenols might open preventive measures using simple dietary recommendations. METHODS: We assessed the ability of continuous administration of high-dose polyphenols to modulate hepatic metabolism and microRNA expression in diet-induced fatty liver disease in commercially available hyperlipidemic mice using well-established and accepted procedures that included the development of new antibodies against modified quercetin. RESULTS: Weight gain, liver steatosis, changes in the composition of liver tissue, and insulin resistance were all attenuated by the continuous administration of polyphenols. We also demonstrated that metabolites of polyphenols accumulate in immune cells and at the surface of hepatic lipid droplets indicating not only bioavailability but a direct likely action on liver cells. The addition of polyphenols also resulted in changes in the expression of miR-103, miR-107 and miR-122. CONCLUSIONS: Polyphenols prevent fatty liver disease under these conditions. The differential expression of mRNAs and miRNAs was also associated with changes in lipid and glucose metabolism and with the activation of 5'-adenosine monophosphate-activated protein kinase, effects that are not necessarily connected. miRNAs function via different mechanisms and miRNA-mRNA interactions are difficult to ascertain with current knowledge. Further, cell models usually elicit contradictory results with those obtained in animal models. GENERAL SIGNIFICANCE: Our data indicate that plant-derived polyphenols should be tested in humans as preventive rather than therapeutic agents in the regulation of hepatic fatty acid utilization. A multi-faceted mechanism of action is likely and the regulation of liver miRNA expression blaze new trails in further research.

Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study.

INTRODUCTION AND OBJECTIVES: To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice. METHODS: A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. RESULTS: In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5-34.8%) in the intervention group and 25.6% (22.3-29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3-11.3%) in the intervention group and 11% (7.4-16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97-101.91 cm) and 102.58 cm (95% CI, 100.96-104.21 cm), respectively (P=.07). Overall, 20.9% (15.6-27.7%) of patients in the intervention group and 29.6% (23.9-36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4-37.9%) in the intervention group and 41.4% (35.8-47.3%) in the control group had depression (P=.02). CONCLUSIONS: A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced.

Ensayo clínico aleatorizado para evaluar la eficacia de un programa integral de prevención secundaria de las enfermedades cardiovasculares en atención primaria: estudio PREseAP / Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study

Introducción y objetivos. Evaluar la eficacia de un programa integral de prevención secundaria de las enfermedades cardiovasculares en atención primaria. Métodos.Ensayo clínico aleatorizado, pragmático, por conglomerados realizado en atención primaria. Eran pacientes elegibles varones y mujeres menores de 86 años, diagnosticados de cardiopatía isquémica, accidente cerebrovascular o enfermedad arterial periférica entre enero de 2004 y mayo de 2005. Participaron en el estudio pacientes visitados en 42 centros de salud de todo el estado español. La variable de resultado fue la combinación de la mortalidad total y los reingresos hospitalarios por causa cardiovascular a los 3 años de seguimiento. Resultados. Se reclutó a 1.224 pacientes, 624 en el grupo intervención y 600 en el grupo control. La variable principal de resultado se observó en el 29,9% (intervalo de confianza del 95%, 25,5-34,8) en el grupo intervención y en el 25,6% (22,3-29,2) en el grupo control (p=0,15). Al final del seguimiento un 8,5% (6,3-11,3) del grupo intervención y un 11% (7,4-16) del grupo control eran fumadores (p=0,07). El perímetro abdominal del grupo intervención fue 100,44 (98,97-101,91) cm y el del grupo control, 102,58 (100,96-104,21) cm (p=0,07). El 20,9% (15,6-27,7) de los pacientes del grupo intervención y el 29,6% de los pacientes del grupo control (23,9-36,1) tenían ansiedad (p=0,05), y el 29,6% (22,4-37,9) del grupo intervención y el 41,4% (35,8-47,3) del grupo control tenían depresión (p=0,02). Conclusiones. Un programa integral de prevención secundaria no es eficaz para reducir la morbimortalidad cardiovascular, pero sí en mejorar algunos aspectos relacionados con los hábitos saludables y en reducir la ansiedad y la depresión (AU)

Introduction and objectives: To assess the efficacy of a comprehensive programof secondary prevention of cardiovascular disease in general practice. Methods: A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. Results: In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5–34.8%) in the intervention group and 25.6% (22.3–29.2%) in the control group (P = .15). At the end of follow-up, 8.5% (6.3–11.3%) in the intervention group and 11% (7.4–16%) in the control group were smokers (P = .07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97–101.91 cm) and 102.58 cm (95% CI, 100.96–104.21 cm), respectively (P = .07). Overall, 20.9% (15.6–27.7%) of patients in the intervention group and 29.6% (23.9–36.1%) in the control group suffered from anxiety (P = .05), and 29.6% (22.4–37.9%) in the intervention group and 41.4% (35.8–47.3%) in the control group had depression (P = .02). Conclusions: A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced (AU)

Benefits of risk factor modification through cardiac rehabilitation.

In the last few decades cardiac rehabilitation has evolved dramatically. It consists of a multidisciplinary approach for secondary prevention and rehabilitation treatment after an individual has sustained a cardiac event. A key principle for successful cardiac rehabilitation management is the modification of risk factors which have been demonstrated to have a significant impact on overall mortality and morbidity outcomes. This article summarizes some of the evidence that supports modification of risk factors through the use of cardiac rehabilitation.

Hip migration percentage in children with cerebral palsy treated with botulinum toxin type A.

OBJECTIVE: To determine hip radiographic findings in children with cerebral palsy (CP) treated with botulinum toxin type A (BTX-A). DESIGN: Retrospective chart review with correlation to radiographic findings. SETTING: Academic center. PARTICIPANTS: Sixteen subjects with CP. INTERVENTION: BTX-A treatment to adductor muscles. MAIN OUTCOME MEASURE: The Reimers hip migration percentage before and after BTX-A. RESULTS: Thirty-two hips in 16 children with CP were treated. We examined the effect of initial migration percentage and initial migration percentage age on the change in migration percentage after BTX-A injection. A significant effect for initial migration percentage (<30% or >/=30%; F=19.05, P <.001) and a significant interaction between initial migration percentage and initial migration percentage age (F=7.5, P <.01) was noted. Initial migration percentage age (24 mo) was not significant (F=.95, P =.34). Patients who had an initial migration percentage of 30% or more and were less than 24 months old were more likely to have a decrease in migration percentage after BTX-A injection compared with patients who were older than 24 months and who had an initial migration percentage of 30% or more. CONCLUSIONS: Improvement in hip migration percentage after BTX-A injection is a function of age and the initial migration percentage. BTX-A injections to adductor muscles may be beneficial for some children with CP.