A promising 'single' and 'dual' drug-nanocomposite enriched contact lens for the management of glaucoma in response to the tear fluid enzyme.

Glaucoma is a neurodegenerative condition that results in the damage of retinal ganglion cells due to elevated intraocular pressure (IOP). To curtail the limitations associated with conventional treatments such as eye drops and ocular suspensions, we have developed 'single' and 'dual' drug delivery contact lenses (CLs), that is, latanoprost (LP) and latanoprost-timolol (LP-TM) deliverable CLs, in response to lysozyme (Lyz), which is abundant in the lacrimal fluid. Since chitosan (CS) can entrap more of the drug and also undergo hydrolysis in the presence of Lyz, we have employed CS for the composite preparation. The CL fabrication was performed by free radical copolymerization of poly(2-hydroxyethyl methacrylate) (pHEMA) in the presence of the drug-loaded nanocomposite with UV-curing initiators using the pre-drug loading strategy. The surface morphological, optical and mechanical investigations confirmed the presence of the drugs, ≥80% transparency, the adequate flexibility and biocompatibility of both the CLs. The in vitro release experiments showed the release of 95.86% LP from LP-CL, and 83.87% LP and 86.70% TM from LP-TM-CL in the presence of 1.5 mg mL-1 of Lyz in 72 h. In vitro biocompatibility assay against human corneal epithelial (HCE) cells and ex vivo experiments on HET-CAM confirmed that the fabricated LP-CL and LP-TM-CL are well tolerated. Moreover, in vivo safety evaluations of CLs on New Zealand white rabbit eyes suggest no sign of irritation to the ocular tissues within 72 h of observation. Hence, the study suggests that the 'single' and 'dual' drug-loaded CLs could open a new avenue to manage glaucoma by maintaining mean diurnal IOP.

A lead selective dimeric quinoline based fluorescent chemosensor and its applications in milk and honey samples, smartphone and bio-imaging.

Dimeric quinoline-based Schiff base was developed (DQS) for the specific detection of Pb2+ ion via fluorimetry. DQS coordinates with Pb2+, a variation in fluorescence intensity with enhanced radical blue shift was observed due to the restriction of CN rotation, CN isomerization, and photoinduced electron transfer (PET) mechanisms. In addition, the intramolecular charge transfer (ICT) from electron-donating morpholine to phenylene diamine acceptor linked quinoline bridge is responsible for the blue-shifted fluorescence enhancement in the DQS-Pb2+ complex. The binding stoichiometry of DQS: Pb2+ (1:2) was confirmed by host-guest titration and mass spectrometry. The limit of detection (LOD) of the DQS was found to be 1.3 × 10-7 M for Pb2+ ion. The DQS sensing ability of Pb2+ was further applied into milk and honey samples, smartphone, bio-imaging and to construct of an INHIBIT molecular logic gate.

Synthesis, antibacterial, anti-oxidant and molecular docking studies of imidazoquinolines.

Quinoline and imidazole derivatives have been playing a significant role in functional bioactivities and were potentially used as antibacterial, antifungal, anticancer, and anti-inflammatory drugs. Owing to the limitation of drug resistance, herein we synthesized thio-, chloro-, and hydroxyl-functionalized various imidazoquinolines by molecular hybridization approach. All the imidazoquinoline derivatives were examined for their antibacterial activity against selected bacterial pathogens by the agar well diffusion method. In addition, the anti-oxidant efficacy of imidazoquinolines was also tested using ferric reducing antioxidant power (FRAP). Among them, electron-withdrawing (-Cl) substituent containing imidazoquinoline 5f showed higher antibacterial and anti-oxidant activities than other imidazoquinolines and reached the effectiveness of the standard. In addition, compounds 4f, 5e, and 3f showed moderate antibacterial activity and other derivatives displayed weak activity against various pathogens. Molecular docking studies were also performed on selected imidazoquinoline derivatives (3f, 4f, and 5f), which showed high docking score and strong binding energy values. These results revealed that thio-imidazoquinoline could assist as a prototype for the designing of multidrug-resistant antibiotics against various microbial organisms.

Smartphone enabled miniaturized temperature controller platform to synthesize nio/cuo nanoparticles for electrochemical sensing and nanomicelles for ocular drug delivery applications.

Undoubtedly, various kinds of nanomaterials are of great significance due to their enormous applications in diverse areas. The structure and productivity of nanomaterials are heavily dependent on the process used for their synthesis. The synthesizing process plays a vital role in shaping nanomaterials effectively for better productivity. The conventional method requires expensive and massive thermal instruments, a huge volume of reagents. This paper aims to develop an Automatic Miniaturized Temperature Controller (AMTC) device for the synthesis of nickel oxide (NiO), copper oxide (CuO) nanoparticles, and nanomicelles. The device features a low-cost, miniaturized, easy-to-operate with plug-and-play power source, precise temperature control, and geotagged real-time data logging facility for the producing nanoparticles. With a temperature accuracy of ± 2 °C, NiO and CuO nanoparticles, and nanomicelles are synthesized on AMTC device, and are subjected to different characterizations to analyze their morphological structure. The obtained mean size of NiO and CuO is 27.14 nm and 85.13 nm respectively. As a proof-of-principle, the synthesized NiO and CuO nanomaterials are validated for electrochemical sensing of dopamine, hydrazine, and uric acid. Furthermore, the study is conducted, wherein, Dexamethasone (Dex) loaded nanomicelles are developed using AMTC device and compared to the conventional thin-film hydration method. Subsequently, as a proof-of-application, the developed nanomicelles are evaluated for transcorneal penetration using exvivo goat cornea model. Ultimately, the proposed device can be utilized for performing a variety of controlled thermal reactions on a minuscule platform with an integrated and miniaturized approach for various applications.

Quinoline based reversible fluorescent probe for Pb2+; applications in milk, bioimaging and INHIBIT molecular logic gate.

We report the modular design and synthesis of an amine dangled Schiff base quinoline-morpholine conjugate (QMC) for highly selective detection of Pb2+ ions via fluorimetry. The sensing strategy of QMC towards Pb2+ ion exhibits a large blue shift with fluorescent enhancement via the intramolecular charge transfer (ICT) process. At the same time, QMC coordination with Pb2+, the CN single bond rotation between quinoline and morpholine rings and the CN isomerization process were blocked. Best of our knowledge, this is the first blue shifted turn-on fluorescent chemosensor for Pb2+ ion via the ICT process. Furthermore, QMC selectively detects Pb2+ ion without any interference with alkali, alkaline earth, and transition metal ions, and limit of detection (LOD) downs to 13 µM, which is a permissible level of Pb2+ ion in drinking water reported by WHO. The 1:2 binding stoichiometry between QMC and Pb2+ was confirmed by fluorimetric, 1H NMR titration, mass spectrometry, and theoretical studies. Finally, QMC was potentially applied for the sensing of Pb2+ ions in milk, red wine, live cells and an INHIBIT molecular logic function was constructed by using Pb2+ and EDTA as chemical inputs.

Triphenyl-imidazole based reversible coloro/fluorimetric sensing and electrochemical removal of Cu2+ ions using capacitive deionization and molecular logic gates.

A simple hydroxyl-substituted triphenyl-imidazole based receptor (HTPI) which selectively detects Cu2+ ion by colorimetric and fluorimetric methods was developed. HTPI detects the Cu2+ ions with the absorption enhancement and fluorescence quenching by the possible ligand to metal charge transfer (LMCT) and the chelation-enhanced quenching (CHEQ) approaches, respectively. HTPI showed high selectivity and sensitivity for Cu2+ ions detection over other interfering and competing metal ions. Interestingly, HTPI detects Cu2+ ion (LOD) at nanomolar concentrations (19 × 10-9 M (UV-vis) & 27 × 10-9 M (fluorescence), respectively), which is lower than the permissible level of Cu2+ ion reported by World Health Organization (WHO). Furthermore, HTPI was applied to the molecular logic gate function by using chemical inputs, and Cu2+ ion was potentially removed (95%) via Capacitive Deionization technique.

Pyrene-phenylglycinol linked reversible ratiometric fluorescent chemosensor for the detection of aluminium in nanomolar range and its bio-imaging.

Pyrene-phenylglycinol tangled ratiometric sensor (R)-1 was developed for the detection of Al3+ ion over other metal ions. Ratiometric behaviour of (R)-1 for Al3+ ion explained through monomer emission and excimer quenching leads to avoiding the π-π interactions of bis-pyrene rings. Pull-push to push-pull binding mechanism is successfully explained by DFT and sensing of Al3+-ions demonstrated in living cells. The LOD of (R)-1 for Al3+ downs to nanomolar concentrations which is lower than the allowed concentration of drinking water set by the (World Health Organization) WHO.

High-depth, high-accuracy microsatellite genotyping enables precision lung cancer risk classification.

There remains a large discrepancy between the known genetic contributions to cancer and that which can be explained by genomic variants, both inherited and somatic. Recently, understudied repetitive DNA regions called microsatellites have been identified as genetic risk markers for a number of diseases including various cancers (breast, ovarian and brain). In this study, we demonstrate an integrated process for identifying and further evaluating microsatellite-based risk markers for lung cancer using data from the cancer genome atlas and the 1000 genomes project. Comparing whole-exome germline sequencing data from 488 TCGA lung cancer samples to germline exome data from 390 control samples from the 1000 genomes project, we identified 119 potentially informative microsatellite loci. These loci were found to be able to distinguish between cancer and control samples with sensitivity and specificity ratios over 0.8. Then these loci, supplemented with additional loci from other cancers and controls, were evaluated using a target enrichment kit and sample-multiplexed nextgen sequencing. Thirteen of the 119 risk markers were found to be informative in a well powered study (>0.99 for a 0.95 confidence interval) using high-depth (579x±315) nextgen sequencing of 30 lung cancer and 89 control samples, resulting in sensitivity and specificity ratios of 0.90 and 0.94, respectively. When 8 loci harvested from the bioinformatic analysis of other cancers are added to the classifier, then the sensitivity and specificity rise to 0.93 and 0.97, respectively. Analysis of the genes harboring these loci revealed two genes (ARID1B and REL) and two significantly enriched pathways (chromatin organization and cellular stress response) suggesting that the process of lung carcinogenesis is linked to chromatin remodeling, inflammation, and tumor microenvironment restructuring. We illustrate that high-depth sequencing enables a high-precision microsatellite-based risk classifier analysis approach. This microsatellite-based platform confirms the potential to create clinically actionable diagnostics for lung cancer.

A dual analyte fluorescent chemosensor based on a furan-pyrene conjugate for Al3+ & HSO3.

A simple chalcone based dual analyte fluorescent probe FPC for Al3+ and HSO3- ions was developed. FPC detects both the analytes through a "turn off-on" approach and by the PET and ICT mechanism. FPC showed high selectivity and sensitivity for Al3+ and HSO3- ions detection over other interfering and competing metal ions. In addition, the LOD of FPC for sensing Al3+ and HSO3- ions was found to be 1.60×10-7M and 0.17×10-6M respectively. An electrochemical desalination technique was employed for the complete removal of Al3+ ions from the environmental water samples by using the probe FPC.

A simple chalcone-based ratiometric chemosensor for silver ion.

Herein, we report the selective binding of Ag(+) ion by the anthracene-based chalcone receptor 1. Receptor 1 behaves as a selective and sensitive chemosensor for the recognition of Ag(+) over other heavy and transition metal ions without any interference and is capable of detecting the metal ion down to 0.15 × 10(-6) M. Receptor 1 on binding with Ag(+) ions exhibits a ratiometric fluorescence enhancement, which is due to the inhibition of photoinduced electron transfer along with the intramolecular charge transfer mechanism.

Development of fluorescent lead II sensor based on an anthracene derived chalcone.

A simple anthracene based chalcone as a fluorescent chemosensor 1, capable of detecting Pb(2+) in aqueous media, has been synthesized by the reaction between pyridine 2-carboxaldehyde and 9-acetyl anthracene. The Pb(2+) recognition processes follows a photo induced electron transfer (PET) mechanism and are scarcely influenced by other coexisting metal ions. In addition, determination of lead in a variety of samples was also determined.

Specific fluorescent sensing of aluminium using naphthalene benzimidazole derivative in aqueous media.

Naphthalene benzimidazole conjugate bearing a hydroxyl group was synthesized. Its binding properties towards various metal ions were examined and it showed a high selectivity and sensitivity towards Al(3+) ions in aqueous media. The recognition processes follows a photo induced electron transfer (PET) mechanism assisted with the restricted intramolecular C-C single bond rotation and are scarcely influenced by other coexisting metal ions. In addition, determination of Al(3+) in a variety of sewage water samples was also determined.

Anti-inflammatory action of exendin-4 in human islets is enhanced by phosphodiesterase inhibitors: potential therapeutic benefits in diabetic patients.

AIMS/HYPOTHESIS: Exendin-4, a glucagon-like peptide-1 (GLP-1) analogue, is reported to have modest anti-inflammatory effects in addition to that of improving beta cell survival. We therefore sought to determine whether exendin-4 decreases expression of the gene encoding chemokine (C-X-C motif) ligand (CXCL)10, which plays a role in initiating insulitis in type 1 diabetes. METHODS: The expression of CXCL10 in human islets was determined at the mRNA level by real-time RT-PCR analysis and at the protein level by western blotting. The level of CXCL10 in culture medium was measured by ELISA. Pathway-specific gene expression profiling was carried out to determine the expression of a panel of genes encoding chemokines and cytokines in human islets exposed to cytokines. RESULTS: IFN-γ induced expression of CXCL10 through activation of signal transducer and activator of transcription-1 (STAT-1). A combination of cytokines (IL-1ß, TNF-α and IFN-γ) showed strong synergy in the induction of numerous chemokines and cytokines through nuclear factor kappa B and STAT-1. Exendin-4 suppressed basal expression of several inflammatory mediators. In combination with phosphodiesterase inhibitors, exendin-4 also decreased IFN-γ-induced CXCL10 expression in human islets and in MIN6 cells (a mouse beta cell line), and its secretion into the culture medium. Exendin-4 action was mimicked by forskolin, an activator of adenylyl cyclase, and by dibutyryl cyclic AMP. Protein kinase A was not involved in mediating exendin-4 action on CXCL10. The mechanism of exendin-4's anti-inflammatory action involved decreases in STAT-1 levels. CONCLUSIONS/INTERPRETATION: These findings suggest that the GLP-1-cyclic AMP pathway decreases islet inflammation in addition to its known effects on beta cell survival.

Visceral & subcutaneous abdominal fat in relation to insulin resistance & metabolic syndrome in non-diabetic south Indians.

BACKGROUND & OBJECTIVES: The objective of the study was to determine whether visceral or subcutaneous component of abdominal fat was associated with insulin resistance and metabolic syndrome in non- diabetic Asian Indians. METHODS: This cross-sectional study had on 120 individuals with normal glucose tolerance (49 males and 71 females). A single slice CT scan at L4- L5 was done for measurement of visceral and subcutaneous abdominal fat. Metabolic syndrome was defined according to the South Asian Modified National Cholesterol Education Program Adult Treatment Panel III criteria (SAM-NCEP) criteria. Insulin Sensitivity Index (ISI-Matsuda) was used to assess insulin sensitivity/resistance. RESULTS: Linear regression analysis revealed that visceral, but not subcutaneous fat was associated with serum triglycerides (R(2);=0.457,beta= 0.34; P=0.006), HDL cholesterol (R(2);=0.430, beta= -0.051; P=0.018) and ISI-Matsuda (R(2);=0.437, beta= -0.05; P=0.039) after adjusting for age, gender and BMI. Visceral fat showed significant association with metabolic syndrome (OR: 1.013, 95% CI: 1.001- 1.025; P=0.041) even after adjusting for age, gender, body mass index and glycated haemoglobin whereas subcutaneous fat did not show such an association. INTERPRETATION & CONCLUSION: These results indicate that in non-diabetic Asian Indians, visceral, but not subcutaneous component of abdominal fat is associated with insulin resistance, cardiovascular risk factors and metabolic syndrome.

Cytokine-mediated induction of anti-apoptotic genes that are linked to nuclear factor kappa-B (NF-kappaB) signalling in human islets and in a mouse beta cell line.

AIMS/HYPOTHESIS: The destruction of pancreatic beta cells leading to type 1 diabetes in humans is thought to occur mainly through apoptosis and necrosis induced by activated macrophages and T cells, and in which secreted cytokines play a significant role. The transcription factor nuclear factor kappa-B (NF-kappaB) plays an important role in mediating the apoptotic action of cytokines in beta cells. We therefore sought to determine the changes in expression of genes modulated by NF-kappaB in human islets exposed to a combination of IL1beta, TNF-alpha and IFN-gamma. METHODS: Microarray and gene set enrichment analysis were performed to investigate the global response of gene expression and pathways modulated in cultured human islets exposed to cytokines. Validation of a panel of NF-kappaB-regulated genes was performed by quantitative RT-PCR. The mechanism of induction of BIRC3 by cytokines was examined by transient transfection of BIRC3 promoter constructs linked to a luciferase gene in MIN6 cells, a mouse beta cell line. RESULTS: Enrichment of several metabolic and signalling pathways was observed in cytokine-treated human islets. In addition to the upregulation of known pro-apoptotic genes, a number of anti-apoptotic genes including BIRC3, BCL2A1, TNFAIP3, CFLAR and TRAF1 were induced by cytokines through NF-kappaB. Significant synergy between the cytokines was observed in NF-kappaB-mediated induction of the promoter of BIRC3 in MIN6 cells. CONCLUSIONS/INTERPRETATION: These findings suggest that, via NF-kappaB activation, cytokines induce a concurrent anti-apoptotic pathway that may be critical for preserving islet integrity and viability during the progression of insulitis in type 1 diabetes.

Accelerated platelet activation in Asian Indians with diabetes and coronary artery disease--The Chennai Urban Population Study (CUPS-13).

AIM: To assess platelet activation in south Indian type 2 diabetic subjects with and without CAD. METHODS: Four groups of subjects were studied; Group 1 comprised of non-diabetic subjects without coronary artery disease (CAD) (n = 30). Type 2 diabetic subjects without CAD formed Group 2 (n = 30); Group 3 comprised of type 2 diabetic subjects with CAD (n = 30) and Group 4 consisted of non- diabetic subjects with CAD (n=14). CAD was diagnosed based on coronary angiographic evidence of severe double or triple vessel disease. Platelet activation was tested after an overnight fast in blood obtained from a bleeding wound at 1 minute post-incision (wound-induced activation) as well as venous blood stimulated in vitro with collagen, using whole blood flow cytometry. In subjects with CAD, aspirin was withdrawn for 7 days and nitrates for 24 hours. RESULTS: Collagen induced GP IIb/IIIa binding was significantly higher among diabetic subjects with (28.10 +/-19.89; p<0.05) and without CAD (21.02+/-19.62; p<0.05) and non-diabetic subjects with CAD (23.89+/-15.65; p<0.05) compared to non-diabetic subjects without CAD (11.69+/-13.69). Regression analysis showed collagen induced GP IIb/IIIa binding to be significantly associated with CAD [odds ratio (OR): 1.029, p = 0.025] and diabetes (OR: 1.037, p = 0.007). CONCLUSION: Increased platelet activation is seen in urban south Indians with diabetes and CAD.

Association of C-reactive protein with body fat, diabetes and coronary artery disease in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-6).

OBJECTIVE: The aim of the study was to determine the association of high sensitivity C-reactive protein (hs-CRP) with body fat, diabetes and coronary artery disease (CAD) in an urban south Indian population. DESIGN: The study was conducted on 150 subjects selected from the Chennai Urban Rural Epidemiology Study (CURES), an ongoing population-based study on a representative population of Chennai (formerly Madras). Group 1 comprised of non-diabetic subjects without CAD (n = 50). Type 2 diabetic subjects without CAD formed Group 2 (n = 50); Group 3 comprised of Type 2 diabetic subjects with CAD (n = 50). CAD was diagnosed based on electrocardiographic (ECG) changes suggestive of ST segment depression and/or Q wave changes using appropriate Minnesota codes. All study subjects were non-smokers, and had no infectious or inflammatory diseases. The plasma levels of hs-CRP were measured using a highly sensitive nephelometric assay. Body fat was calculated using Siri's formula using skin fold measurements. RESULTS: Diabetic subjects with (2.89 mg/l) and without (2.25 mg/l) CAD had significantly higher hs-CRP levels compared with non-diabetic subjects without CAD (0.99 mg/l, P < 0.001). hs-CRP values increased with increases in tertiles of body fat (ANOVAP < 0.001) and HbA1c (ANOVAP < 0.001). Multiple logistic regression analysis revealed hs-CRP to be strongly associated with CAD (OR: 1.649, P = 0.040) and diabetes (OR: 2.264, P = 0.008) even after adjusting for age and gender. Regression analysis also revealed body fat to be strongly associated with diabetes and CAD even after adjusting for age and gender (P < 0.001). hs-CRP influenced this association for diabetes but not for CAD. CONCLUSION: hs-CRP showed a strong association with CAD and diabetes, even after adjusting for age and gender. The association of body fat with diabetes seems to be mediated through hs-CRP. However, hs-CRP does not appear to mediate the relationship between body fat and CAD.

Association of small dense LDL with coronary artery disease and diabetes in urban Asian Indians - the Chennai Urban Rural Epidemiology Study (CURES-8).

OBJECTIVE: Earlier studies in Europeans have identified small dense LDL to be associated with coronary artery disease and diabetes. In this study we assessed the association of small dense LDL with diabetes and CAD in Asian Indians. METHODS: Study subjects were selected from the Chennai Urban Rural Epidemiology Study (CURES), a population based study on representative sample of Chennai city in southern India. Group 1:non-diabetic subjects (n = 30); Group 2: diabetic subjects without CAD (n = 30); Group 3:diabetic subjects with CAD (n = 30). LDL subfractions were estimated using LipoPrint LDL system. LDL subfractions 3 and above, defined as small dense LDL was summed up to determine the overall small LDL. 75th percentile of the overall small dense LDL in non-diabetic subjects was used as a cut-off for defining elevated levels of small dense LDL. RESULTS: The mean age of the study subjects was not significantly different among groups. Overall small dense LDL was significantly higher in diabetic subjects with CAD (16.7 +/- 11.1 mg/dl, p < 0.05) and without CAD (11.1 +/- 8.0 mg/dl, p < 0.05) compared to non-diabetic subjects without CAD (7.2 +/- 6.8 mg/dl). Small dense LDL showed a positive correlation with fasting plasma glucose (r = 0.252, p = 0.023), HbA1c (r = 0.281, p = 0.012), total cholesterol (r = 0.443, p < 0.001), triglycerides(r = 0.685, p < 0.001), LDL(r = 0.342, p = 0.002), total cholesterol/HDL ratio (r = 0.660, p = < 0.001) and triglycerides/HDL ratio(r = 0.728, p < 0.001) and a negative correlation with HDL cholesterol (r = -0.341, p = 0.002) and QUICKI values (r = -0.260, p = 0.019). ROC curves constructed to predict elevated small dense LDL ((9.0 mg/dl) revealed that triglycerides/HDL ratio and total cholesterol/HDL ratio had higher AUC values compared to other parameters. A triglycerides/HDL ratio of 3.0 had the optimum sensitivity (80.0%) and specificity (78.0%) for detecting elevated small dense LDL. CONCLUSION: This data suggests that in Asian Indians, small dense LDL is associated with both diabetes and CAD and that a triglycerides/HDL ratio (3.0 could serve a surrogate marker of small dense LDL.

Phytochemical and antimicrobial studies of extracts of solanum xanthocarpum.

Antibacterial activity of various parts (stem, leaf and fruits) of solvent extracts (Petroleum ether, alcohol and acetone) of Solanum xanthocarpum against Escherichia coil, Klebsiella of Solanum xanthocarpum showed high sensitivity to Escherichia coil & less sensitivity and resistance to Bacillus cereus. In control, no inhibitory zone was observed.

Relationship of lipoprotein(a) with intimal medial thickness of the carotid artery in Type 2 diabetic patients in south India.

OBJECTIVE: The objective of this study was to investigate the association of lipoprotein(a) [Lp(a)] levels with intimal medial thickness (IMT) in Type 2 diabetic patients in south India. STUDY DESIGN: We studied 587 consecutive Type 2 diabetic patients at the M.V. Diabetes Specialities Centre, Chennai. The mean age of the study group was 55 +/- 10 years and 71.2% were males. IMT of the right common carotid artery was determined using high-resolution B mode ultrasonography. Lp(a) levels were measured using ELISA. Since the frequency distribution of Lp(a) was skewed, Lp(a) values were log transformed and the geometric mean was used for statistical analysis. The tertiles of IMT were determined to analyse the association of Lp(a) and other factors with IMT. RESULT: The mean Lp(a) level in the study patients was 18.9 +/- 3.1 mg/dl (geometric mean +/- sd) and the mean IMT of the study subjects was 0.93 +/- 0.19 mm (mean +/- sd). The prevalence of carotid atherosclerosis (defined as IMT > 1.1 mm) among subjects with elevated Lp(a) levels > 20 mg/dl was significantly higher compared with those with Lp(a) levels