Smoking is a risk factor for pulmonary metastasis in colorectal cancer.

AIM: The hepatic microenvironment, which may include chronic inflammation and fibrosis, is considered to contribute to the pathogenesis of liver metastases of colorectal cancer. A similar mechanism is anticipated for pulmonary metastases, although no reports are available. Smoking causes pulmonary inflammation and fibrosis. Thus, we hypothesized that smokers would be especially affected by pulmonary metastases of colorectal cancer. In this study, we attempted to clarify the impact of smoking on pulmonary metastasis of colorectal cancer. METHOD: Between September 2005 and December 2010 we reviewed 567 patients with pathological Stage I, II or III colorectal cancer, whose clinicopathological background included a preoperative smoking history, pack-year history from medical records. Univariate and multivariate analyses using the Cox proportional hazard model were performed to determine the independent prognostic factors for pulmonary metastasis-free survival. RESULTS: Pulmonary metastases occurred in 39 (6.9%) patients. The smoking histories revealed 355 never smokers, 119 former smokers and 93 current smokers among the subjects. Multivariate analysis revealed that being a current smoker (hazard ratio = 2.72, 95% CI 1.18-6.25; P = 0.02) was an independent risk factor for pulmonary metastases. CONCLUSION: Smoking may be a risk factor for pulmonary metastasis of colorectal cancer. Cessation of smoking should be recommended to prevent pulmonary metastasis, although further basic and clinical studies are required.

Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery.

BACKGROUND: One of the potential advantages of laparoscopic compared with open colorectal surgery is a reduction in postoperative bowel obstruction events. Early reports support this proposal, but accumulated evidence is lacking. METHODS: A systematic review and meta-analysis was performed of randomized clinical trials and observational studies by searching the PubMed and Cochrane Library databases from 1990 to August 2015. The primary outcomes were early and late postoperative bowel obstruction following laparoscopic and open colorectal surgery. Both ileus and bowel obstruction were defined as a postoperative bowel obstruction. Subgroup and sensitivity analyses were performed, and a random-effects model was used to account for the heterogeneity among the studies. RESULTS: Twenty-four randomized clinical trials and 88 observational studies were included in the meta-analysis; 106 studies reported early outcome and 12 late outcome. Collectively, these studies reported on the outcomes of 148 392 patients, of whom 58 133 had laparoscopic surgery and 90 259 open surgery. Compared with open surgery, laparoscopic surgery was associated with reduced rates of early (odds ratio 0·62, 95 per cent c.i. 0·54 to 0·72; P < 0·001) and late (odds ratio 0·61, 0·41 to 0·92; P = 0·019) postoperative bowel obstruction. Weighted mean values for early postoperative bowel obstruction were 8 (95 per cent c.i. 6 to 10) and 5 (3 to 7) per cent for open and laparoscopic surgery respectively, and for late bowel obstruction were 4 (2 to 6) and 3 (1 to 5) per cent respectively. CONCLUSION: The reduction in postoperative bowel obstruction demonstrates an advantage of laparoscopic surgery in patients with colorectal disease.

Mutations in the TRKA/NGF receptor gene in patients with congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA; MIM 256800) is an autosomal-recessive disorder characterized by recurrent episodes of unexplained fever, anhidrosis (absence of sweating) and absence of reaction to noxious stimuli, self-mutilating behaviour and mental retardation. The genetic basis for CIPA is unknown. Nerve growth factor (NGF) induces neurite outgrowth and promotes survival of embryonic sensory and sympathetic neurons. Mice lacking the gene for TrkA, a receptor tyrosine kinase for NGF, share dramatic phenotypic features of CIPA, including loss of responses to painful stimuli, although anhidrosis is not apparent in these animals. We therefore considered the human TRKA homologue as a candidate for the CIPA gene. The mRNA and genomic DNA encoding TRKA were analysed in three unrelated CIPA patients who had consanguineous parents. We detected a deletion-, splice- and missense-mutation in the tyrosine kinase domain in these three patients. Our findings strongly suggest that defects in TRKA cause CIPA and that the NGF-TRKA system has a crucial role in the development and function of the nociceptive reception as well as establishment of thermoregulation via sweating in humans. These results also implicate genes encoding other TRK and neurotrophin family members as candidates for developmental defect(s) of the nervous system.

Safety and feasibility of laparoscopic surgery for elderly rectal cancer patients in Japan: a nationwide study.

BACKGROUND: This study aimed to analyse the perioperative results from a national dataset of rectal cancer resections in elderly patients. METHODS: The clinical records of patients undergoing rectal cancer surgery between 2012 and 2014 were retrieved from the Japanese National Clinical Database and analysed retrospectively. Patients were categorized according to age and those 80 years or older were defined as elderly. Subgroups were also defined according to the surgical approach (laparoscopy versus open surgery). The short-term outcomes, including mortality, anastomotic leak, surgical site infections and medical complications were compared between subgroups. RESULTS: Of 56 175 patients undergoing rectal cancer surgery, some 6717 patients were elderly and laparoscopy was performed in 46.8 per cent of the sample. When comparing laparoscopy and open surgery in elderly patients, the operative mortality rate (1.5 versus 2.8 per cent; P < 0.001), the incidence of anastomotic leakage (5.2 versus 6.5 per cent; P = 0.026), surgical site infections (6.0 versus 8.0 per cent; P = 0.001), pneumonia (1.4 versus 2.5 per cent; P = 0.001), renal failure (0.7 versus 1.3 per cent; P = 0.016) and cardiac events (0.3 versus 0.8 per cent; P = 0.008) were lower for laparoscopy than for open surgery. The overall complication rate in elderly patients (19.5 per cent) was comparable to that in the younger group (P = 0.07). However, incidence of systemic complications was significantly higher in elderly than in younger patients (all P < 0.001). CONCLUSION: Laparoscopy was safe and feasible in elderly patients compared with open surgery. However, the rates of systemic complications were significantly higher than in younger patients.

Effect of high ligation on survival of patients undergoing surgery for primary colorectal cancer and synchronous liver metastases.

BACKGROUND: Although R0 surgery is recommended for stage IV colorectal cancer, the degree of required lymphadenectomy has not been established. The aim of this study was to investigate the prognostic impact of high ligation (HL) of the feeding artery and the number of retrieved lymph nodes after R0 surgery for colorectal cancer and synchronous colorectal cancer liver metastasis (CRLM). METHODS: This was a multi-institutional retrospective analysis of patients with colorectal cancer and synchronous CRLM who had R0 surgery between January 1997 and December 2007. Clinical and pathological features were compared in patients who underwent HL and those who had a low ligation (LL). Kaplan-Meier analysis was performed to estimate the effect of HL on overall survival (OS). The impact of several risk factors on survival was analysed using the Cox proportional hazards model. RESULTS: Of 549 patients, 409 (74·5 per cent) had HL. Median follow-up was 51·4 months. HL significantly improved the 5-year OS rate (58·2 per cent versus 49·3 per cent for LL; P = 0·017). Multivariable analysis revealed HL to be a significant prognostic factor compared with LL (5-year mortality: hazard ratio (HR) 0·68, 95 per cent c.i. 0·51 to 0·90; P = 0·007). In subgroup analysis, the positive effect of HL on OS was greatest in patients with lymph node metastasis. CONCLUSION: HL of the feeding artery was associated with improved OS in patients with colorectal cancer and synchronous CRLM after R0 surgery.

ANTECEDENTES: Aunque se recomienda una cirugía R0 para el cáncer colorrectal (colorectal cancer, CRC) en estadio IV, no se ha establecido el grado de linfadenectomía requerida. El objetivo de este estudio fue investigar el impacto pronóstico de la ligadura alta (high ligation, HL) de la arteria que irriga el tumor y el número de ganglios linfáticos (lymph nodes, LN) identificados después de cirugía R0 en pacientes con cáncer colorrectal y metástasis hepáticas sincrónicas (colorectal cancer liver metastasis, CRLM). MÉTODOS: En este estudio se realizó un análisis retrospectivo multicéntrico de pacientes con CRC y CRLM sincrónicas en los que se realizó una cirugía R0 desde enero de 1997 hasta diciembre de 2007. Se compararon las características clínicas y patológicas entre los pacientes a los que, durante la cirugía R0, se practicó una HL frente a los que no se practicó esta técnica. El análisis de Kaplan-Meier se realizó para estimar el efecto de la HL en la supervivencia global (overall survival, OS). El impacto de varios factores de riesgo sobre la supervivencia se analizó utilizando el modelo de Cox de riesgo proporcional. RESULTADOS: Sobre un total de 549 pacientes, se realizó una HL en 409 (74,5%), y el período de seguimiento medio en esta cohorte fue de 51,4 meses. La HL mejoró significativamente la tasa de OS a los 5 años (HL 37,7% versus no HL 27,1%, P = 0,02). El análisis multivariable mostró que la HL era un factor pronóstico significativo en comparación con la no realización de una HL (cociente de riesgos instantáneos, hazard ratio, HR de muerte a 5 años = 0,68 (i.c. del 95% 0,51-0,90), P < 0,01)). En el análisis de subgrupos, el efecto positivo de la HL sobre la OS fue mayor en pacientes con metástasis ganglionares. CONCLUSIÓN: La ligadura alta de la arteria que irriga el tumor se asoció con una mejor OS en pacientes con CRC y CRLM sincrónicas después de una cirugía R0.

Hyperinsulinemia and the development of ST-T electrocardiographic abnormalities. An 11-year follow-up study.

OBJECTIVE: It has been suggested that insulin resistance and consequent hyperinsulinemia promote atherosclerosis, but few prospective studies have reported the relationships between hyperinsulinemia and the development of ST-T abnormalities in the 12-lead resting electrocardiogram (ECG) in populations in which atherosclerosis is rare. RESEARCH DESIGN AND METHODS: A total of 304 Japanese men and women, aged 20-69 years, selected for having high blood glucose or more than a trace-positive urine glucose from a population-based health examination in 1981, were followed for 11 years. Of these, 33 died, 1 from myocardial infarction, while 260/271 living were reexamined in 1992. The 237 subjects with a normal ECG at the baseline examination were analyzed. RESULTS: Incident ST-T abnormalities occurred in 13/237 people. Insulin concentrations were positively associated with the development of ST-T abnormalities (relative risk approximately 8, comparing those in the highest versus lowest quartile of insulin values). Adjustment for age, sex, and systolic blood pressure or other risk factors had little effect on this relationship. CONCLUSIONS: Hyperinsulinemia was related to the development of ST-T abnormalities in ECGs in the absence of the development of clinical signs of atherosclerosis, independent of blood pressure and other risk factors in men and women with mild glucose intolerance.

Serum N-acetyl-beta-D-glucosaminidase activity in predicting the development of hypertension.

We conducted a prospective study in residents of a small farming community in southwestern Japan to determine whether elevated serum N-acetyl-beta-D-glucosaminidase (NAG) activity would predict future hypertension. The 505 normotensive subjects (blood pressure, < 140/90 mm Hg; mean age, 52 +/- 12 years) were reexamined after 7 years; 111 (22%) had become hypertensive (defined as blood pressure > or = 140/90 mm Hg and/or taking antihypertensive medication at follow-up). After adjustment for age and sex, the development of hypertension was significantly related to body mass index (P < .002), the sum of skinfolds (P < .001), baseline blood pressure (P < .0001), serum cholesterol (P < .01), serum uric acid level (P < .0001), and serum NAG activity (P < .005). Elevated NAG activity showed an independent relationship to future hypertension (P < .005) after adjustments for age, sex, baseline blood pressure (systolic, diastolic, or mean), uric acid level, and the sum of skinfolds. Therefore, elevated serum NAG activity was an effective indicator of future hypertension, and it might therefore be related to functional and/or structural changes in the cardiovascular system.

Interleukin-1 inhibits human thyroid carcinoma cell growth.

In order to further clarify the growth regulating effect of cytokines on thyroid cell proliferation, the effect of interleukin-1 (IL-1) was tested on growth of human papillary and follicular thyroid carcinoma cells (NPA and WRO). Although fetal bovine serum stimulated DNA synthesis, TSH did not affect cell growth and the level of thyroglobulin messenger RNA (mRNA) in NPA. Eight-bromo-cAMP and forskolin, however, significantly suppressed DNA synthesis, suggesting the impairment of TSH receptor signal transduction in NPA cells despite of the presence of [125I]TSH binding. Both IL-1 alpha and beta inhibited [3H] thymidine uptake into NPA cell DNA in a dose- and time-dependent manner at concentrations ranging from 5 x 10(2) to 10(5) U/L; 10(5) U/L of IL-1 suppressed DNA synthesis by more than 40% of control. The suppressive activity of IL-1 beta was more potent than that of IL-1 alpha in spite of the same lymphocytes activating factor (LAF) activity. Steady state levels of c-myc mRNA transcripts were also inhibited by both IL-1 alpha and beta, respectively. On the other hand, IL-1 alpha and beta did not affect the WRO cell growth. Although forskolin stimulated cAMP production in NPA cells, IL-1 did not induce cAMP generation. Indomethacin (1.0 approximately 10 mg/L) did not alter the suppressive activity of IL-1. Neither IL-1 alpha and beta caused a cytotoxic effect on the NPA cells. Although changes in c-myc mRNA content may just be an epiphenomenon of the decrease in proliferative activity in response to IL-1, and not a direct target of action of the peptide, these results demonstrate the inhibitory effect of IL-1 on cell growth of NPA. IL-1 may have an aspect of antitumorigenic action in some human thyroid carcinoma differentiation and replication.

Expression of the putative membrane fatty acid transporter (FAT) in taste buds of the circumvallate papillae in rats.

The putative membrane fatty acid transporter (FAT) protein and its mRNA, originally expressed in adipose tissue, were found in the tongue of rats. Northern blot analysis showed a significant expression of FAT mRNA in the epithelial layer of circumvallate papillae. Immunohistochemical staining revealed that immunoreactivity for FAT is specifically localized in the apical part of taste bud cells, possibly gustatory cells, in the circumvallate papillae.

Effects of age at menopause on serum cholesterol, body mass index, and blood pressure.

Pre- and postmenopausal cholesterol (mg/dl), body mass index (BMI; kg/m(2)), and systolic blood pressure (SBP; mmHg) levels were compared in three age-at-time-of-menopause (ATM) groups to examine the relationship between the three risk factors and age ATM. Cholesterol, BMI, and SBP levels recorded 4 years prior to and 8 years after menopause were examined and increases in these risk factors between the two measurements were noted. The three age groups were: group A (n=49; age ATM [44+/-1]<45), group B (n=395; 45< or =age ATM [48+/-1]<50), and group C (n=578; age ATM [52+/-2]> or =50). Cholesterol levels in premenopausal groups A (169+/-31 mg/dl, 40 years) and B (174+/-31, 44 years) were lower than those in group C (179+/-30, 48 years) (0.05< or =P<0.1 and P<0.05). Because, the increases in cholesterol were greater in group A (41+/-28 mg/dl) than in groups B (32+/-28) and C (29+/-28) (0.05< or =P<0.1 and P<0.05), cholesterol levels were identical among groups despite age differences upon reaching the postmenopause phase: group A (210+/-34, 51 years), group B (206+/-35, 56 years) and group C (208+/-35, 60 years). BMI and SBP increases were not different in groups A, B, and C. Differences in BMI and SBP levels among groups in order of premenopausal age were still observed after menopause. These data suggest that the greater increase in cholesterol associated with early menopause may be related to a higher prevalence of ischemic heart disease (IHD) in younger menopausal women.

Hyperinsulinaemia as a predictor of hypertension: an 11-year follow-up study in Japan.

OBJECTIVE: To examine the hypothesis that hyperinsulinaemia is associated with the development of borderline hypertension or hypertension. DESIGN: Blood pressure status in non-obese normotensives (< 140/90 mmHg, n = 135) people were re-examined after 11 years after the baseline examination. Participants were selected from a 1981 population-based health examination and had a high blood glucose level or more than a trace of glucose in their urine. Out of 319 people recruited for further examination of glucose tolerance status, 135 normotensive participants with body mass index < 26 kg/m2 and without diabetes according to World Health Organization criteria were re-examined at the follow-up survey. RESULTS: Sixty-two (46%) out of 135 normotensive participants were hypertensive (defined as blood pressure > or = 140/90 mmHg) or receiving antihypertensive medication (n = 8) at the follow-up survey. Significant associations between the development of hypertension and baseline parameters were observed for systolic and diastolic blood pressure, serum triglycerides, high-density lipoprotein (HDL)-cholesterol, fasting and 60 min post-load insulin levels, and the sum of insulin concentrations from fasting to 180 min after glucose challenge after adjustments for age and sex. Odds ratios (95% confidence intervals) for the future development of hypertension between the highest and the lowest tertiles of insulin levels were 4.06 (1.40-11.76) for fasting insulin, 4.25 (1.45-12.45) for 60 min post-glucose load insulin, and 3.88 (1.34-11.20) for the sum of insulin concentrations, after adjustment for age, sex, systolic blood pressure, body mass index and alcohol consumption. Further adjustments for serum triglycerides and serum creatinine did not affect the insulin-hypertension relationship. CONCLUSION: The present study suggests that hyperinsulinemia is significantly related to the development of hypertension in non-obese and non-diabetic Japanese people.

Phasic coronary artery flow velocity determined by Doppler flowmeter catheter in aortic stenosis and aortic regurgitation.

Phasic coronary artery flow velocity was recorded in 14 patients with aortic regurgitation (AR), 4 with aortic stenosis, 61 with other heart diseases and in 2 normal subjects by means of a bidirectional Doppler flowmeter catheter. The normal pattern of the phasic coronary artery flow velocity was characterized by a small forward flow during systole (S wave) and a large forward flow during diastole (D wave). The phasic coronary artery flow velocity in patients with AR showed increased S wave and decreased D wave. The area under the S-wave curve divided by the area under the D-wave curve (S/D ratio) in patients with AR increased (left coronary artery flow velocity 0.66 +/- 0.39, p less than 0.05; right coronary flow velocity 0.79 +/- 0.36, p less than 0.01) as compared with the S/D ratio in patients with other heart diseases (left coronary flow velocity 0.32 +/- 0.12; right coronary artery flow velocity 0.38 +/- 0.17). There was a tendency toward a relative positive correlation between S/D ratio values and AR cineangiographic grades. Decreased S/D ratios were observed in 4 patients with aortic stenosis. It is believed that no reports exist on phasic coronary flow velocity recorded in conscious patients who had aortic valve disease.

Stimulatory effect of retinoic acid on GH gene expression: the interaction of retinoic acid and tri-iodothyronine in rat pituitary cells.

We have previously demonstrated that retinoic acid (RA) as well as thyroid hormone stimulates GH gene expression. To clarify the relationship between the action of RA and thyroid hormone, pituitary-specific gene expression was investigated further in rat pituitary cells. Rat clonal pituitary cells, GH3, were treated with RA with or without tri-iodothyronine (T3) for up to 3 days. After treatment with 10-1000 nmol RA/l with or without 0.1-10 nmol T3/l, medium was collected for radioimmunoassay and cells were subjected to RNA extraction, and GH and prolactin gene expression was analysed using 32P-labelled rat GH and rat prolactin cDNA probes respectively. The data demonstrated the dose-responsive manner of the stimulatory effects of RA and T3 on GH secretion with T3-depleted media. The action of RA was additive to that of T3 for GH secretion when maximum effective doses of RA or T3 were used. Using dot blot and Northern gel analysis, it was shown that RA increased GH mRNA levels in T3-depleted media, and that this action of RA was additive to that of T3 on the induction of GH mRNA levels. In contrast, neither RA nor T3 stimulated the secretion of prolactin and prolactin mRNA levels in these cells. Our results indicate that RA stimulates GH mRNA increment and GH secretion in T3-depleted media, and that the stimulatory effect of RA is additive to the maximum effective dose of T3.

Heart rate and mortality in a Japanese general population: an 18-year follow-up study.

The predictive power of elevated heart rate for total mortality was evaluated in a Japanese general population. A total of 573 male participants, aged 40 to 64, who underwent a health examination in 1977, were followed until 1994. Heart rate (beats per minute; bpm) was measured using an electrocardiogram. During the 18 years, 82 subjects died; 18 from cerebro-cardiovascular diseases and 36 from cancer. In a multivariate proportional hazards regression model, age, elevated systolic and diastolic blood pressures, antihypertensive medication, heart rate, uric acid, vital capacity (inversely), and serum cholesterol (inversely) were significantly associated with all-cause death. Of these variables, elevated heart rate was the strongest predictor of all-cause death after adjustment for age. Resting heart rate levels were classified into five groups: < 60 (G1), 60-69 (G2), 70-79 (G3), 80-89 (G4), and > or = 90 (G5) bpm. Heart rates of 60-69 (G2) bpm showed the lowest death rate (14.3%) and heart rate > or = 90 (G5) bpm showed the highest death rate (38.2%) after adjustments for age and other confounding factors. The relative risk of G2 versus G5 was 2.68. An increased mortality risk was shown in men whose heart rate was > or = 90 bpm. Moreover, a continuous model suggested a graded increase in risk, so that risk is likely elevated even for heart rates less than 90 bpm, and lowest risk may be around 60 bpm.

Association between alcohol intake and development of hypertension in Japanese normotensive men: 12-year follow-up study.

Although it has been suggested that alcohol intake is related to hypertension, few long-term prospective studies have investigated this relationship. We therefore conducted a prospective study in male residents of a farming community in Japan to determine whether heavy drinking would predispose to the development of hypertension. A total of 325 normotensive (< 140/90 mm Hg) men were enrolled in 1977. Twelve years later, 93 (28.6%) subjects became hypertensive (defined as blood pressure > or = 140/90 mm Hg or use of antihypertensive medication). The probability of the development of hypertension in heavy drinkers predicted from a logistic regression equation was 44.6% (relative risk: 2.05 versus nondrinkers) after adjusting for age and body mass index (BMI). It was 36.2% (relative risk: 1.86 versus nondrinkers) after a further adjustment for systolic blood pressure at baseline. A high odds ratio of 2.39 for the development of hypertension with alcohol intake of < 46 g/day versus > or = 46 g/day at baseline was obtained even after adjustments for age, BMI, and confounding factors. We conclude that habitual heavy drinking of alcohol is a risk factor for the development of hypertension. This is the first report demonstrating a significant relationship between habitual alcohol intake and the development of hypertension in a long-term prospective study in Japan.

Generation of leukotrienes and hydroxyeicosatetraenoic acids in peritoneal macrophages of tumor-bearing mice.

To examine the potential role of lipoxygenase products in the pathophysiology observed after experimental tumor implantation, we examined the generation of leukotrienes (LTs) and hydroxyeicosatetraenoic acids (HETEs) in peritoneal macrophages. C57BL/6 mice were given subcutaneous inoculations of B16 melanoma cells, and peritoneal macrophages were isolated various days after the inoculation. Macrophages were incubated for 1 h at 37 degrees C in serum-free RPM11640 containing 10 microM calcium ionophore A23187, 10 microM exogenous arachidonic acid (AA), 5 mM cysteine hydrochloride and 1 mM reduced glutathione. LTs and HETEs were separately extracted, passed through Sep-Pak cartridges, then identified and quantitated with a HPLC system using UV absorbance. The B16 melanoma-cell-treated/untreated macrophages were found to produce substantial amounts of 15-HETE, 12-HETE and 5-HETE and LTC4 by enzymatic mechanisms. Thus, when determined under various conditions, the production of HETEs was dependent on substrate-concentration, incubation-time and cell-number. The production of LTC4 was dependent on incubation-time and cell number but not substrate-concentration, indicating utilization of endogenous AA stores. Of these products, 12-HETE and LTC4 showed a significant increase on the fourth day after the tumor cell inoculation and returned to the control level by the 11th day after the same treatment. These results suggest that in vivo tumor cell implantation may induce a transient increase of 12-HETE and LTC4 production in macrophages.

Association of hyperinsulinemia and serum free fatty acids with serum high density lipoprotein-cholesterol.

A total of 155 Japanese subjects (79 men and 76 women) who were classified as having normal or borderline glucose tolerance, according to the criteria for the 50-g oral glucose tolerance test (GTT) of the Japanese Diabetes Society, were analyzed for factors related to serum high density lipoprotein (HDL)-cholesterol concentration, especially the responses of insulin and free fatty acid (FFA) after a glucose challenge. In men, significant negative univariate correlations were observed with body mass index (P < 0.01), the summed values of triceps and subscapular skin-folds (P < 0.01), serum insulin concentration at all time intervals, and serum FFA at 30 and 60 min of GTT. Serum insulin at 60, 120, and 180 min, sum insulin, and FFA at 30 and 60 min of GTT were significantly related to serum HDL-cholesterol after adjustment for body mass index and triglyceride concentration. Multiple linear regression analysis with the step-forward method showed that sum insulin (P < 0.01), FFA at 60 min of GTT (P < 0.001), and alcohol consumption (P < 0.01) were independently related to serum HDL-cholesterol concentration. Only the triglyceride concentration was inversely correlated (P < 0.05) with HDL-cholesterol concentration in women. These data indicate that both insulin and FFA concentration, as markers of insulin resistance, apparently influence on HDL kinetics in men, but not in women. The lack of this association in women was appeared to related to the degree of obesity.

Effects of Y-20811, a long-lasting thromboxane synthetase inhibitor, on thromboxane production and platelet function.

Effects of a new imidazole derivative, sodium 4-[alpha-hydroxy-5-(imidazolyl)-2-methylbenzyl]-3,5-dimethyl benzoate dihydrate (Y-20811), on thromboxane (TX) production and platelet aggregation were investigated. Y-20811 inhibited TX synthetase (IC50 = 2.2 X 10(-8) M) and platelet aggregation induced by arachidonic acid (AA) in human, guinea pig and rabbit platelets in vitro. Administered orally to rabbits, Y-20811 at a dose of 1 mg/kg decreased serum TXB2 concomitant with increasing 6-keto PGF1 alpha and at a dose of 3 mg/kg inhibited AA-induced platelet aggregation, in both cases for at least 48 hours. Y-20811 (0.3 mg/kg/day) administered to rabbits for 7 days decreased serum TXB2 levels by 50-90% during the medication, and these levels were restored to initial values 3 days after withdrawal of the drug. At a dose of 1 mg/kg Y-20811 protected rabbits against death induced by AA (2 mg/kg). These results indicate that Y-20811 is a selective and long-lasting TX synthetase inhibitor and an anti-aggregating agent useful in preventing thrombotic disorders.

Suppressive doses of thyroxine do not accelerate age-related bone loss in late postmenopausal women.

To examine whether suppressive doses of thyroxine have any adverse effects on bone, we evaluated various bone metabolic markers (lectin-precipitated alkaline phosphatase, osteocalcin, carboxyl-terminal region of type I collagen propeptide, tartrate-resistant alkaline phosphatase, and urinary excretion of hydroxyproline and pyridinium crosslinks), incidence of vertebral deformity, total body and regional (lumbar spine and radius) bone mineral densities (BMDs), and rates of bone loss in 24 late postmenopausal (more than 5 years after menopause) women who were treated with levothyroxine (L-T4) after total thyroidectomy for differentiated carcinoma. Depending on the clinical records, including serum TSH levels measured by immunoradiometric assay, these patients were divided into two groups. One group of patients was given suppressive doses of L-T4 (TSH < 0.1 mU/L, n = 12) and the other group was given nonsuppressive doses of L-T4 (TSH > 0.1 mU/L, n = 12). There was no difference in bone metabolic markers and incidence of vertebral deformity between the groups. In patients with TSH suppression, Z-scores of BMDs calculated from age-matched healthy women (n = 179, aged 55 to 80) were nearly in the zero range of values (0.077 at total body, 0.228 at lumbar spine, and -0.117 at trabecular region of lumbar spine). The rate of bone loss in TSH-suppressed patients (-0.849 +/- 0.605%/year) was not significantly different from that of nonsuppressed patients (-0.669 +/- 0.659). These prospective and cross-sectional data suggest that long-term levothyroxine therapy using suppressive doses has no significant adverse effects on bone.

Clustering of cardiovascular risk factors in hyperinsulinemia in Japanese without diabetes.

Clustering of cardiovascular risk factors in hyperinsulinemia was investigated in 247 Japanese subjects without diabetes. After adjustment for age and sex, the highest quartile of the summed values of insulin concentrations after oral glucose loading showed high odds ratios (OR; 95% confidence intervals) for the prevalence of cardiovascular risk factors: OR = 2.02 (1.07-3.83) for hypertension, 3.91 (1.82-8.40) for hypertriglyceridemia, 2.41 (1.30-4.46) for low high-density lipoprotein cholesterol, 2.41 (1.28-4.51) for impaired glucose tolerance, and 3.58 (1.44-8.88) for high uric acid. Two or more of these factors were clinically elevated in 50% of those in the highest quartile of the summed values of insulin, compared to 16-28% of those in the lower three quartiles. These findings were slightly attenuated after further adjustment for body mass index and sum of skinfolds. In conclusion, multiple risk factors for cardiovascular disease existed in the subjects with hyperinsulinemia in Japanese without diabetes.