Lipocalin 2 as a potential systemic biomarker for central serous chorioretinopathy.

No systemic biomarker of Central Serous Chorioretinopathy (CSCR) has been identified. Lipocalin 2 (LCN2 or NGAL), alone or complexed with MMP-9 (NGAL/MMP-9), is increased in several retinal disorders. Serum levels of LCN2 and NGAL/MMP-9 were measured in CSCR patients (n = 147) with chronic (n = 76) or acute/recurrent disease (n = 71) and in age- and sex-matched healthy controls (n = 130). Samples with CRP > 5 mg/L, creatinine > 100 µmol/L, and/or urea > 7.5 mmol/L were excluded. Serum LCN2 was lower in CSCR patients than controls (81.4 ± 48.7 vs 107.3 ± 44.5 ng/ml, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.006). Serum NGAL/MMP-9 was lower in CSCR patients than controls (47.2 ± 40.7 vs 74.1 ± 42.6, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.002). A ROC curve showed that for LCN2 serum levels, the 80-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 80.3% sensitivity and 75.8% specificity, and for NGAL/MMP-9 serum levels, a 38-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 69.6% sensitivity and 80.3% specificity. In both acute and chronic CSCR, low serum LCN2 and NGAL/MMP-9, provide a biological link between the two CSCR forms, and potential susceptibility to oxidative stress and innate immune dysregulation in CSCR.

Optimal treatment of renal artery in-stent restenosis: repeat stent placement versus angioplasty alone.

OBJECTIVE: We investigated whether repeat renal artery stent placement compared with treatment with balloon angioplasty alone results in better patency in patients presenting with renal artery in-stent restenosis (ISR). BACKGROUND: Although stent placement for renal artery stenosis has been demonstrated to be superior to balloon angioplasty for "de novo" renal artery lesions, the optimal therapy for ISR remains unclear. METHODS: Between January 1997 and August 2006, 34 consecutive patients (41 renal arteries) with ISR were treated at the discretion of the operator with balloon angioplasty or repeat stent placement. Quantitative angiography was performed before and immediately after intervention and at follow-up. Angiographic follow-up was obtained for clinical indications in 75% of lesions and routine noninvasive follow-up imaging was obtained in 95% of lesions. RESULTS: Repeat renal artery stent placement demonstrated improved patency compared with balloon angioplasty alone with a 58% reduction in recurrent ISR (29.4% vs. 71.4%, P = 0.02) and a 30% reduction in follow-up diameter stenosis (41% vs. 58.2%, P = 0.03). The repeat stent group also had better secondary patency (P = 0.05) and a greater freedom from repeat ISR (P = 0.01) when compared with balloon angioplasty alone. There was a trend favoring repeat stent placement for cumulative freedom from target vessel revascularization (TVR) (P = 0.08). CONCLUSIONS: Repeat stent placement appears to result in superior patency compared with balloon angioplasty alone for the treatment of renal ISR.

Identification of time point to best define 'sub-optimal response' following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data.

PurposeTo determine the average time-point at which it is best to define 'sub-optimal response' after ranibizumab treatment for diabetic macular edema (DME) based on the data obtained from real-life clinical practice.MethodsIn this retrospective observational study, 322 consecutive treatment naïve eyes with DME were treated with three loading doses of intravitreal ranibizumab followed by re-treatment based on decision of the treating physician on a case-by-case basis. The demographic data, clinic-based visual acuity measurements and central subfield thickness (CST) assessed on spectral domain optical coherence tomography (OCT) were evaluated at baseline (month 0), 1, 2, 3, 6, and 12 months.ResultsOn an average, the improvement in visual acuity and CST was first seen after the loading dose. However, the maximal response in terms of proportion of patients with improvement in visual acuity and/ or CST in this cohort was observed at 12 months. Patients who presented with low visual acuity at baseline (<37 ETDRS letters) were unlikely to attain driving vision with ranibizumab therapy.ConclusionsOn an average, a 'sub-optimal response' after ranibizumab therapy is best defined at month 12 as patients may continue to improve with treatment.

Effectiveness of hardiness, exercise and social support as resources against illness.

The effects of the resistance resources of personality hardiness, exercise, and social support, taken singly and in combination, on concurrent and prospective levels, and probability of illness were studied. In 1980, 85 male business executives identified as high in stressful events were tested for the three resistance resources. Predicting their illness scores in 1980 formed the concurrent aspect of the study. For the prospective aspect, illness scores in 1981 were available on 70 of the subjects. With regard to resistance resources, when there are none, one, two or three, the level and probability of both concurrent and prospective illness drop in a regular and marked fashion. These results highlight the importance of multiple resistance resources. Estimates of relative effectiveness indicate that hardiness is the most important of the resistance resources studied.

A prediction model of suicide among youth.

Epidemiological relationships were studied between adolescent (ages 15 to 24 years) suicide rates and population shifts among adolescents. Suicide rates among adolescents tripled from 1956 to 1977 and have subsequently leveled off. Increases (and decreases) in adolescent suicide rates corresponded to increases (and decreases, respectively) in the proportion of adolescents in the United States. Opposite trends have been found among older age groups. Projected population fluctuations were used to predict trends in adolescent suicide rates to the year 2000: the current decrease in rates is predicted to continue until the mid-1990s. Recent data indicating a decrease in adolescent suicide rates tend to support the population model hypothesis. The data suggest that demographic variables may be of explanatory and predictive use in understanding the epidemiological trends of suicide. Early intervention and prevention strategies emerge from this model, and various social, public health, and research implications exist. However, the results must be viewed with caution because of the methodological problems inherent in using national mortality data, the possibility that other variables may account for the observed relationships, and the length of time required to test such prospective epidemiological propositions.

Type A and hardiness.

The study examined the relationship between the Type A behavior pattern and personality hardiness and predicted an interaction between the two that would be influential for illness onset. Type A and hardiness were found to be conceptually different and empirically independent factors. Under high stressful life events, male executives who were high in Type A and low in hardiness tended toward higher general illness scores than any other executives. Type A and hardiness emerge from this study as bases for extrinsic and intrinsic motivation, respectively.