RESUMEN
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
Asunto(s)
Pueblo Asiatico , Enfermedades Cardiovasculares/etnología , Síndrome Metabólico/etnología , Crecimiento Demográfico , Asia/epidemiología , Pueblo Asiatico/genética , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/genética , Emigrantes e Inmigrantes , Emigración e Inmigración , Epigénesis Genética , Predisposición Genética a la Enfermedad , Disparidades en el Estado de Salud , Humanos , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/genética , Obesidad/etnología , Fenotipo , Prevalencia , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND AND AIMS: Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. METHODS AND RESULTS: A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean ("lean PC") and fat ("fat PC") tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84-0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74-0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95% CI 1.04-1.48, P = 0.02) relative to fat PCs between the 25th-75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). CONCLUSION: Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.
Asunto(s)
Composición Corporal , Enfermedades Cardiovasculares/mortalidad , Sarcopenia/mortalidad , Absorciometría de Fotón , Adiposidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , Causas de Muerte , Comorbilidad , Femenino , Evaluación Geriátrica , Humanos , Masculino , Análisis Multivariante , Prevalencia , Análisis de Componente Principal , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Sarcopenia/fisiopatología , Sarcopenia/terapia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND AND AIMS: Dietary quality affects cardiometabolic risk, yet its pathways of influence on regional adipose tissue depots involved in metabolic and diabetes risk are not well established. We aimed to investigate the relationship between dietary quality and regional adiposity. METHODS AND RESULTS: We investigated 5079 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) who had food-frequency questionnaires and measurement of pericardial fat and hepatic attenuation at the baseline study visit in MESA, as well as a subgroup with imaging for visceral and subcutaneous fat (N = 1390). A dietary quality score (DietQuality) was constructed to include established food group constituents of a Mediterranean-type diet. Linear models estimated associations of dietary score as well as its constituents with regional adiposity. Baseline mean age was 61 (± 10) years, and approximately half of the participants (47%) were male. Those with a higher DietQuality score were generally older, female, with a lower body mass index, C-reactive protein, and markers of insulin resistance. After adjustment, a higher DietQuality score was associated with lower visceral fat (lowest vs. highest dietary score quartile: 523.6 vs. 460.5 cm(2)/m; P < 0.01 for trend), pericardial fat (47.5 vs. 41.3 cm(3)/m; P < 0.01 for trend), lesser hepatic steatosis (by hepatic attenuation; 58.6 vs. 60.7 Hounsfield units; P < 0.01 for trend), but not subcutaneous fat (P = 0.39). Greater fruits, vegetables, whole grains, seeds/nuts and yogurt intake were associated with decreased adiposity, while red/processed meats were associated with greater regional adiposity. CONCLUSION: A higher quality diet pattern is associated with less regional adiposity, suggesting a potential mechanism of beneficial dietary effects on diabetes, metabolic, and cardiovascular risk.
Asunto(s)
Aterosclerosis/prevención & control , Distribución de la Grasa Corporal , Dieta Saludable , Dieta Mediterránea , Anciano , Biomarcadores/sangre , Índice de Masa Corporal , Peso Corporal , Proteína C-Reactiva/metabolismo , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Etnicidad , Femenino , Humanos , Resistencia a la Insulina , Grasa Intraabdominal/metabolismo , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Factores de Riesgo , Factores Socioeconómicos , Grasa Subcutánea/metabolismo , Encuestas y Cuestionarios , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
BACKGROUND AND AIMS: Visceral fat (VF) is a source of pro-inflammatory adipokines implicated in cardiac remodeling. We sought to determine the impact of visceral fat and subcutaneous fat (SQ) depots on left ventricular (LV) structure, function, and geometry in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AND RESULTS: We performed a post-hoc analysis on 1151 participants from MESA with cardiac magnetic resonance quantification of LV mass and LV mass-to-volume ratio (LVMV, an index of concentricity) and computed tomographic-derived SQ and VF area. Multivariable regression models to estimate association between height-indexed SQ and VF area (per cm(2)/m) with height-indexed LV mass (per height(2.7)) and LVMV were constructed, adjusted for clinical, biochemical, and demographic covariates. We found that both VF and SQ area were associated with height-indexed LV mass (ρ = 0.36 and 0.12, P < 0.0001, respectively), while only VF area was associated with LVMV (ρ = 0.28, P < 0.0001). Individuals with above-median VF had lower LV ejection fraction, greater indexed LV volumes and mass, and higher LVMV (all P < 0.001). In multivariable models adjusted for weight, VF (but not SQ) area was associated with LV concentricity and LV mass index, across both sexes. CONCLUSION: Visceral adiposity is independently associated with LV concentricity, a precursor to heart failure. Further study into the role of VF in LV remodeling as a potential therapeutic target is warranted.
Asunto(s)
Aterosclerosis/patología , Obesidad Abdominal/etnología , Remodelación Ventricular , Adipoquinas/metabolismo , Anciano , Índice de Masa Corporal , Etnicidad , Femenino , Ventrículos Cardíacos/patología , Humanos , Grasa Intraabdominal/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Volumen Sistólico , Grasa Subcutánea/patología , Tomografía Computarizada por Rayos X , Estados UnidosRESUMEN
Quantification of actinides in the complex environmental, biological, process and waste streams samples requires multiple steps like selective preconcentration and matrix elimination, solid source preparations generally by evaporation or electrodeposition, and finally alpha spectrometry. To minimize the sample manipulation steps, a membrane based isotope dilution alpha spectrometry method was developed for the determination of plutonium concentrations in the complex aqueous solutions. The advantages of this method are that it is Pu(IV) selective at 3M HNO3, high preconcentration factor can be achieved, and obviates the need of solid source preparation. For this, a thin phosphate-sulfate bifunctional polymer layer was anchored on the surface of microporous poly(ethersulfone) membrane by UV induced surface grafting. The thickness of the bifunctional layer on one surface of the poly(ethersulfone) membrane was optimized. The thickness, physical and chemical structures of the bifunctional layer were studied by secondary ionization mass spectrometry (SIMS), scanning electron microscopy (SEM) and SEM-EDS (energy-dispersive spectroscopy). The optimized membrane was used for preconcentration of Pu(IV) from aqueous solutions having 3-4M HNO3, followed by direct quantification of the preconcentrated Pu(IV) by isotope dilution alpha spectrometry using (238)Pu spike. The chemical recovery efficiency of Pu(IV) was found to be 86±3% below Pu(IV) loading capacity (1.08 µg in 2×1 cm(2)) of the membrane sample. The experiments with single representative actinides indicated that Am(III) did not sorb to significant extent (7%) but U(VI) sorbed with 78±3% efficiency from the solutions having 3M HNO3 concentration. However, Pu(IV) chemical recovery in the membrane remained unaffected from the solution containing 1:1000 wt. proportion of Pu(IV) to U(VI). Pu concentrations in the (U, Pu)C samples and in the irradiated fuel dissolver solutions were determined. The results thus obtained were found to be in good agreement with those obtained by conventional alpha spectrometry, biamperometry and thermal ionization mass spectrometry.
Asunto(s)
Plutonio/análisis , Polímeros/química , Técnicas de Dilución del Indicador , Espectrometría de Masas/métodos , Membranas Artificiales , PorosidadRESUMEN
BACKGROUND: Acute neurologic deficits occur in up to 40% of patients with left heart endocarditis. Appropriate evaluation and management of patients with acute neurologic dysfunction who require valve operations for endocarditis remain controversial. This retrospective review was undertaken to develop recommendations for the evaluation and treatment of these challenging patients. METHODS: From 1983 to 1995, 247 patients underwent operations for left heart native valve endocarditis at the Johns Hopkins Hospital. From a review of medical and pathology records, 34 patients (14%) with preoperative neurologic deficits were identified. Data on these 34 patients were recorded and analyzed. RESULTS: Causes of neurologic dysfunction included embolic cerebrovascular accident (n = 23, 68%), embolic cerebrovascular accident with hemorrhage (n = 4, 12%), ruptured mycotic aneurysm (n = 3, 9%), transient ischemic attack (n = 2, 6%), and meningitis (n = 2, 6%). Preoperative diagnostic studies included computed tomography (32 patients), magnetic resonance imaging (11 patients), cerebral angiogram (14 patients), and lumbar puncture (2 patients). Computed tomography demonstrated structural lesions in 29 of 32 patients; in only 1 patient did magnetic resonance imaging reveal a lesion not already seen on computed tomography. Of 14 patients having cerebral angiograms, 7 had a mycotic aneurysm. Three mycotic aneurysms had ruptured, and these were clipped before cardiac operations. The mean interval from onset of neurologic deficit to cardiac operation was 22.2 +/- 2.8 days for all patients and 22.1 +/- 3.0 days for those with embolic cerebrovascular accident. The hospital mortality rate was 6%. New or worse neurologic deficits occurred in 2 patients (6%). CONCLUSIONS: Neurologic deficits are common in patients with endocarditis referred for cardiac operations. Despite substantial preoperative morbidity, most of these patients do well if the operation can be delayed for 2 to 3 weeks. Computed tomography scan is the preoperative imaging technique of choice, as routine magnetic resonance imaging and cerebral angiogram are unrewarding. Cerebral angiogram is indicated only if computed tomography reveals hemorrhage.
Asunto(s)
Endocarditis Bacteriana/cirugía , Prótesis Valvulares Cardíacas , Enfermedades del Sistema Nervioso/complicaciones , Infecciones Estafilocócicas/cirugía , Infecciones Estreptocócicas/cirugía , Enfermedad Aguda , Adolescente , Adulto , Anciano , Válvula Aórtica , Baltimore/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/mortalidad , Femenino , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/mortalidad , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/mortalidad , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/mortalidadRESUMEN
Nine consecutive patients with HCL seen over a period of five years were reviewed. Male: Female ratio was 8:1. Median age at diagnosis was 49 years. Weakness and fatigue (66%) were the commonest presenting symptoms and splenomegaly (66%) was the commonest physical findings. Varying degrees of pancytopenia was the consistent feature in majority of cases. Diagnosis was made on the basis of bone marrow biopsy and characteristic EM picture. Forty-four percent of cases developed serious infection during their clinical course. Gram negative bacilli and fungi were the most frequently isolated organisms. Major sites of infections were pneumonia and septicemia. Splenectomy was carried out in four cases. Rapid recovery of haematological parameters without any significant complication was observed in all these cases. Two patients were treated with alfa-interferon. In both the cases recovery of haematological parameters was slow compared to those under going splenectomy. One patient treated with alfa-interferon died due to infection related complications while the other went into remission.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia de Células Pilosas , Adulto , Anciano , Quimioterapia Adyuvante , Preescolar , Ciclofosfamida/administración & dosificación , Femenino , Humanos , Interferón-alfa/uso terapéutico , Leucemia de Células Pilosas/sangre , Leucemia de Células Pilosas/complicaciones , Leucemia de Células Pilosas/terapia , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Esplenectomía , Vincristina/administración & dosificaciónRESUMEN
Histochemical demonstration of beta-glucuronidase was carried out in the normal and regenerating tail of the house lizard, Hemidactylus flaviviridis. Greater enzyme activity was particularly discernible in the stratum germinativum of the skin of the normal and fully regenerated tail. During regeneration most of the cellular elements of the blastema and the differentiating regenerate exhibited enzyme activity. Distribution of the enzyme beta-glucuronidase is correlated with the high degree of cellular proliferation. The role of the enzyme in the catabolism of mucopolysaccharides is also implicated during the wound-healing phase. In the full-grown regenerate the intensity and distribution of the enzyme activity were found to be the same as those observed in the normal tail.
Asunto(s)
Glucuronidasa/metabolismo , Lagartos/metabolismo , Regeneración , Cola (estructura animal)/enzimología , Animales , Piel/enzimología , Cola (estructura animal)/fisiologíaRESUMEN
In order to understand the role of visceral fat bodies in regeneration, a histomorphological analysis of the fat bodies in Mabuya during its tail regeneration was undertaken. The investigation revealed 2 interesting aspects; a visible shrinkage of the fat bodies and a fall in the histosomatic index (HSI), as well as an enhancement in haemopoietic activity and infiltration of lymphocytes in the fat bodies during the 1st 7 days of tail regeneration. These observations are taken to indicate the involvement of visceral fat bodies in the regenerative mechanics. The appearance of lymphocytes on the 5th and 7th days and their subsequent disappearance together with lipid depletion are construed from the functioning of lymphocytes in lipid transport during their passage to the wound site.
Asunto(s)
Hematopoyesis , Lagartos/fisiología , Regeneración , Animales , Cuerpo Adiposo/anatomía & histología , Cuerpo Adiposo/metabolismo , Metabolismo de los Lípidos , Lagartos/anatomía & histología , Cola (estructura animal)/fisiologíaRESUMEN
Histochemical studies on the activities of alpha-GPDH, LDH, SDH and MDH in liver have been carried out during the different phases of tail regeneration in the lizard, Hemidactylus flaviviridis. Changes in the metabolic activities of the liver during regeneration indicate that during the initial phases of regeneration (namely, wound healing and blastema formation) the energetics of the hepatic tissue are anaerobically oriented, but later (i.e. during the growth phase) the TCA cycle appears to be predominant.
Asunto(s)
Hígado/enzimología , Lagartos/fisiología , Oxidorreductasas/metabolismo , Regeneración , Animales , Glicerolfosfato Deshidrogenasa/metabolismo , Histocitoquímica , L-Lactato Deshidrogenasa/metabolismo , Lagartos/metabolismo , Malato Deshidrogenasa/metabolismo , Succinato Deshidrogenasa/metabolismo , Cola (estructura animal)/fisiologíaRESUMEN
The concentration of ascorbic acid (AA) and the histochemical distribution of this vitamin together with cytochrome oxidase have been investigated in the normal and regenerating tail of the Scincid lizard, Mabuya carinata. An interesting aspect of this investigation is the observation of a total lack of cytochrome oxidase in both the normal and regenerating tail of the lizard, except for the differentiating phase. On the other hand, AA has been found to be present in the normal and regenerating tail with above normal levels during wound healing (twofold) and differentiation (fivefold). In the light of the poor cytochrome oxidase activity, the higher content of AA noted during regeneration has been construed to play a possible role in the respiratory mechanics of the regenerating lizard tail. Further, the importance of AA in cellular metabolism and the wound healing and differentiative processes have also been discussed.
Asunto(s)
Ácido Ascórbico/metabolismo , Complejo IV de Transporte de Electrones/metabolismo , Lagartos/metabolismo , Regeneración , Cola (estructura animal) , Animales , Cola (estructura animal)/fisiología , Cicatrización de HeridasRESUMEN
OBJECTIVE: To characterize descriptively the histologic and temperature effects of intradiskal electrothermal annuloplasty on human cadaveric lumbar disks. DESIGN: In vitro histologic study. SETTING: Hospital-based soft-tissue research laboratory. CADAVERS: Six human cadaveric lumbar disks, from 5 cadavers aged 39 to 79 who died from nonspine-related causes. INTERVENTIONS: Intradiskal electrothermal therapy (IDET) by using a standard high-temperature heating protocol with the temperature of the probe gradually increased from 65 degrees C to 90 degrees C over 16.5 minutes. Disks were stained and examined by light microscopy and electron microscopy. MAIN OUTCOME MEASURES: Temperatures in outer annulus, gross macroscopic changes, and histologic damage. RESULTS: Gross inspection showed a small circumferential area of tissue alteration localized to the posterior annulus but not extending to the endplates. Light microscopy of the posterior aspect of the lumbar disks showed denaturation, shrinkage, and coalescence of annular collagen; the anterior portions, which served as internal controls, showed no evidence of damage. The endplates were structurally preserved and showed no evidence of damage. Electron microscopy showed extensive collagen disorganization, decreased quantity of collagen, collagen fibril shrinkage, and chondrocyte damage when compared with a control portion. The temperature curves showed parallel changes in temperature at the level of the probe and at the posterior portion of the disk. CONCLUSIONS: IDET raises temperatures sufficiently to induce collagen denaturation and coalescence. These histologic changes may play a substantial role in the clinical efficacy of IDET.
Asunto(s)
Electrocoagulación/normas , Disco Intervertebral/cirugía , Disco Intervertebral/ultraestructura , Dolor de la Región Lumbar/patología , Dolor de la Región Lumbar/cirugía , Adulto , Anciano , Temperatura Corporal , Cadáver , Condrocitos/ultraestructura , Enfermedad Crónica , Colágeno/ultraestructura , Electrocoagulación/efectos adversos , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Humanos , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/fisiopatología , Microscopía Electrónica , Persona de Mediana Edad , Factores de TiempoRESUMEN
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare but well-documented lesion of neuroectodermal derivation. Maturation of the neural elements has been reported only occasionally. We report a case of MNTI of the maxilla showing maturation of neural elements to ganglionic cells.